| NPI | 1922403922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KASIE Y. NAM Dentist 317-257-3368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IN 12010943) |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2014-11-03 |