Provider Demographics
NPI:1003290388
Name:JAMES TOWNE DDS2, LLC
Entity Type:Organization
Organization Name:JAMES TOWNE DDS2, LLC
Other - Org Name:JAMESTOWNE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-353-4469
Mailing Address - Street 1:6249 S EAST ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2091
Mailing Address - Country:US
Mailing Address - Phone:317-789-1000
Mailing Address - Fax:
Practice Address - Street 1:6249 S EAST ST
Practice Address - Street 2:SUITE J
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2091
Practice Address - Country:US
Practice Address - Phone:317-789-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011631A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201026900Medicaid