| 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 |