Provider Demographics
NPI:1033689112
Name:CONDRA COSMETIC AND FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CONDRA COSMETIC AND FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-691-0359
Mailing Address - Street 1:8001 SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5970
Mailing Address - Country:US
Mailing Address - Phone:317-888-7295
Mailing Address - Fax:317-888-7297
Practice Address - Street 1:8001 SHELBY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5970
Practice Address - Country:US
Practice Address - Phone:317-888-7295
Practice Address - Fax:317-888-7297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental