| NPI | 1699211169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA JONES President 317-731-5203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IN 12010266A) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-01-09 |