| NPI | 1881812097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY E SMITH Secretary 317-585-0005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12006427A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12010538A) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |