| NPI | 1992159552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY S. BEARD Office Manager 317-841-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12010961A) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12012362A) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12007255A) | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2016-04-20 |