| NPI | 1508284837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL LEE MILLER Owner/Dentist 317-398-2103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12009483A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12010992A) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2014-04-03 |