| NPI | 1407996291 |
|---|---|
| Doing Business As | DENTAL FACULTY PRIVATE PRACTICE |
| Entity Type | Organization |
| Authorized Contact | JILL ALLEN Clinic Adminstrator 317-278-6946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 1223P0106X Dentist Oral and Maxillofacial Pathology | |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223P0300X Dentist Periodontics | |
| 1223P0700X Dentist Prosthodontics | |
| 1223X0008X Dentist Oral and Maxillofacial Radiology | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2010-04-30 |