| NPI | 1578757191 |
|---|---|
| Doing Business As | ORAL SUGERY AND IMPLANT CENTER OF INDIANA |
| Entity Type | Organization |
| Authorized Contact | BRENT J. BARTA President/Owner 317-247-9512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 120108543A) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12010589A) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12010678A) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2007-08-28 |