| NPI | 1699895995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIQUITA MARQUINEZ PALANCA-BEVERIDGE President 317-337-0233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12009522) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2020-08-22 |