Medical school: INDIANA UNIVERSITY SCHOOL OF DENTISTRY
Graduated: 2006
NPI: 1770716607
Practice Locations (3)
1121 W MICHIGAN ST, DS307B
INDIANAPOLIS, IN 462025186
1121 W MICHIGAN ST, DS307B
INDIANAPOLIS, IN 462025211
PO BOX, SUITE 299
SALT LAKE CITY, UT 84110
Source: CMS National Downloadable File, September 2026.