Provider Demographics
NPI:1043644065
Name:MCCALL DENTURES OF IN, P.C.
Entity Type:Organization
Organization Name:MCCALL DENTURES OF IN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-596-9700
Mailing Address - Street 1:8202 CLEARVISTA PKWY
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1400
Mailing Address - Country:US
Mailing Address - Phone:317-596-9700
Mailing Address - Fax:317-596-9147
Practice Address - Street 1:8202 CLEARVISTA PKWY
Practice Address - Street 2:SUITE 4B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1400
Practice Address - Country:US
Practice Address - Phone:317-596-9700
Practice Address - Fax:317-596-9147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN54001772A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty