| NPI | 1407976335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY MANTOOTH Office Manager 317-271-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12009124A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12009568A) |
| 1223G0001X Dentist, General Practice (Licence: IN 12010071A) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-08-22 |