| NPI | 1669646485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA L DOUGHTY Office Manager 812-490-9995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: IN 12010889A) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2008-04-14 |