| NPI | 1639291958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ANDREW JASTREMSKI Owner Manager 812-339-2811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12009671) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2020-08-22 |