| NPI | 1972891687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE BROOKE SHANK Sole Member 317-888-9833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IN 12011699A) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2016-11-04 |