NPI | 1588995229 |
---|---|
Entity Type | Organization |
Authorized Contact | SHANNON KENNETH MOORE Owner 812-332-1405 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: IN 12010311A) |
Additional Taxonomies | 122300000X Dentist (Licence: IN 12011246A) |
332B00000X Durable Medical Equipment & Medical Supplies | |
Enumeration Date | 2010-01-20 |
Last Update Date | 2022-05-17 |