| NPI | 1720443831 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY DUANE JOHNSON President 317-535-7141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12009239) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2015-12-17 |
| Last Update Date | 2020-10-30 |