| NPI | 1912216482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN CHASE TOOLE Member 317-432-9151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12011012A) |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2010-10-21 |