| NPI | 1659874568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRENE NOSRATI President 317-507-9033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 65156) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 100669) |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2018-03-16 |