| NPI | 1457704447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUANITA R TAYLOR Member/ Dentist 317-986-5930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12011023A) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2016-07-14 |