| NPI | 1386762318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT E TATE Doctor President 812-323-9700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: IN IN12010196A) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2020-08-22 |