| NPI | 1922642743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN RUSSELL YANCEY Dentist Anesthesiologist 317-459-0738 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2019-11-05 |