| NPI | 1740307685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY N BOLT Dentist 317-852-7112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12008249A) |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2020-08-22 |