| NPI | 1982074118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE M SCHAUB Owner 317-884-8633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: IN 12010873A) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12009521A) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2015-09-30 |