NPI | 1528408945 |
---|---|
Entity Type | Organization |
Authorized Contact | ANTHONY IMBURGIA Sole Member 317-997-7930 |
Organization Subpart ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
Enumeration Date | 2013-06-29 |
Last Update Date | 2013-07-01 |