Provider Demographics
NPI:1043879240
Name:INDIAN CREEK FAMILY DENTISTRY
Entity Type:Organization
Organization Name:INDIAN CREEK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:STROPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-597-5857
Mailing Address - Street 1:5938 WEST SR 135
Mailing Address - Street 2:
Mailing Address - City:TRAFALGAR
Mailing Address - State:IN
Mailing Address - Zip Code:46181
Mailing Address - Country:US
Mailing Address - Phone:812-597-5857
Mailing Address - Fax:
Practice Address - Street 1:5938 WEST SR 135
Practice Address - Street 2:
Practice Address - City:TRAFALGAR
Practice Address - State:IN
Practice Address - Zip Code:46181
Practice Address - Country:US
Practice Address - Phone:812-597-5857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12012937AOtherIN DENTAL LICENSE
IN1851883334OtherNPI TYPE 1