Provider Demographics
NPI:1154656775
Name:MAUPIN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MAUPIN FAMILY DENTISTRY
Other - Org Name:SARATOGA FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAUPIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-838-7100
Mailing Address - Street 1:4877 MYRTLE LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-9200
Mailing Address - Country:US
Mailing Address - Phone:317-340-3804
Mailing Address - Fax:
Practice Address - Street 1:1070 WEST MAIN STREET SUITE 151
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-9704
Practice Address - Country:US
Practice Address - Phone:317-838-7100
Practice Address - Fax:317-885-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010749A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty