| NPI | 1487032538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUTH LEE Office Manager 317-373-4164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IN 12010748A) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IN 12010652A) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IN 12011416A) | |
| Enumeration Date | 2015-05-09 |
| Last Update Date | 2015-05-09 |