| NPI | 1376659755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE L MARTIN Dentist Owner 317-257-9103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN IN12010059) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN IN12009976) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2020-08-22 |