| NPI | 1437422680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ESTHER RUSSTOM GHEBREMICHAEL Owner 317-414-8822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IN 12011343A) |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2012-02-20 |