| NPI | 1790058741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ESTHER GHEBREMICHAEL Owner 317-414-8822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12011343A) |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2012-02-21 |