Provider Demographics
NPI:1053459545
Name:W MICHAEL PRINCELL DDS PC
Entity Type:Organization
Organization Name:W MICHAEL PRINCELL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRINCELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-577-2478
Mailing Address - Street 1:7207 N SHADELAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDPLS
Mailing Address - State:IN
Mailing Address - Zip Code:46250
Mailing Address - Country:US
Mailing Address - Phone:317-577-2478
Mailing Address - Fax:317-578-8773
Practice Address - Street 1:7207 N SHADELAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INDPLS
Practice Address - State:IN
Practice Address - Zip Code:46250
Practice Address - Country:US
Practice Address - Phone:317-577-2478
Practice Address - Fax:317-578-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty