| NPI | 1427143643 |
|---|---|
| Doing Business As | INDIANA PERIODONTICS |
| Entity Type | Organization |
| Authorized Contact | KRISTIN M JACKSON Owner 317-887-3180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IN 12009767) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2011-06-16 |