NPI | 1376889568 |
---|---|
Entity Type | Organization |
Authorized Contact | RANDALL J LUCKEY Secretary, Treasurer 317-472-4565 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: IN 12010577) |
Additional Taxonomies | 122300000X Dentist (Licence: IN 12010577) |
Enumeration Date | 2012-12-17 |
Last Update Date | 2013-06-05 |