| NPI | 1972016392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA K PULOS Member 317-485-5850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12008816) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2017-11-07 |