| NPI | 1972936037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD LEO RECEVEUR Dentist/Owner 812-948-2281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12008027) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2017-11-08 |