| NPI | 1871862672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT J BARTA Owner 317-247-9512 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12011062) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 120008543) |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2011-12-22 |