| NPI | 1891137865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVIN PAVLOV CEO 812-603-3996 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: IN 13003577A) |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2013-07-19 |