| NPI | 1700070331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE CHARLES ELLIS Orthodontist 219-322-7645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IN 12009958A) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2007-08-27 |