| NPI | 1922270404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT ALLEN MOORE President 317-348-1354 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IN 12010751A) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2008-03-25 |