| NPI | 1710334131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW FRAIZ Dentist 317-872-3465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12011779A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12011331C) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2016-05-16 |