| NPI | 1518470897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY THURMAN Office Manager 317-842-8453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: IN 12010349A) |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2017-11-09 |