| NPI | 1609286061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL FREDRICK TILLERY Owner 317-291-8957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 7704) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2014-05-06 |