| NPI | 1962173575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALONDRA CAMACHO Administrative Assistant 317-597-0184 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2021-09-23 |