| NPI | 1730610833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESA ALLISON Owner, Managing Member 317-627-1755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12011836A) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2017-03-21 |