| NPI | 1699234955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD LEE MILLER Owner 317-844-6284 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2019-03-17 |