| NPI | 1508133638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA MICHELLE WATKINS Owner 765-282-5655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12010271A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12011056A) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2011-11-17 |