| NPI | 1619163045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD ANDREW HICKMAN Owner/President 317-888-7807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2007-09-19 |