| NPI | 1689067928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK E NICEWANDER Owner 317-842-1903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12007501A) |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2015-04-06 |