Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 12012806A | IN |
NPI | 1740621002 |
---|---|
Provider Name | Dr. Neetha Santosh |
First Address | Indianapolis, IN 46202-5211 |
Second Address | Indianapolis, IN 46202-5211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2013 |
Last Update Date | 17/03/2018 |