| NPI | 1699019489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WHITNEY M MOORE Sole/Owner 317-513-8669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-022597) |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2012-11-16 |