| NPI | 1639467913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY D GILLUM Office Manager 317-888-7576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12008573) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2012-05-17 |