| NPI | 1568557874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD L RECEVEUR Manager Member 812-948-2281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12008027A) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-08-22 |