| NPI | 1740661834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRI J RICHARDSON Office Manager 765-289-0236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 6592) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2015-06-15 |