| NPI | 1447447461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA D GRAY Office Manager 317-491-0188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12010045) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2007-10-04 |