| NPI | 1932569415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK J. REYNOLDS Owner 765-966-7602 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12007171A) |
| Enumeration Date | 2016-02-26 |
| Last Update Date | 2016-02-26 |