| NPI | 1790105203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY S BEARD Office Manager 317-841-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12010961A) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12010160A) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12011603A) | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2014-04-23 |