| NPI | 1386067627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE COOMBS Office Manager 317-898-9231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12007959A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 120111490A) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2014-01-22 |