| NPI | 1699173070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD I PROKES Owner 317-727-1534 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12011722A) |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2014-12-17 |