| NPI | 1699042739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK DONALD SUMMERLIN Owner 317-926-5200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12007409A) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2011-11-17 |