| NPI | 1649380452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRIEDA COOKE President 317-227-0881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12009952) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2017-02-07 |