Provider Demographics
NPI:1134671241
Name:WINDING RIDGE DENTISTRY
Entity Type:Organization
Organization Name:WINDING RIDGE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SULAIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALTONI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-559-5955
Mailing Address - Street 1:10930 PENDLETON PIKE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-2856
Mailing Address - Country:US
Mailing Address - Phone:317-595-5955
Mailing Address - Fax:
Practice Address - Street 1:10930 PENDLETON PIKE
Practice Address - Street 2:SUITE 104
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-2856
Practice Address - Country:US
Practice Address - Phone:317-595-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012029B1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1578798963OtherINDIVIDUAL NPI