| NPI | 1568907582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUTH LEE Practice Administrator 317-527-0066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12010748A) |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2016-12-29 |