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Individual

SARA GHOLAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
1121 W MICHIGAN ST RM 280B, INDIANAPOLIS, IN 46202
(317) 274-5348
Mailing address
1121 W MICHIGAN ST RM 280B, INDIANAPOLIS, IN 46202-5211

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DS042216
PA
390200000X
Student in an Organized Health Care Education/Training Program
LDR170182
IN

Other

Enumeration date
06/20/2017
Last updated
07/02/2019
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