Provider Demographics
NPI:1174639538
Name:POLE, JANET ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:ANNE
Last Name:POLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 N LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-2814
Mailing Address - Country:US
Mailing Address - Phone:317-297-4502
Mailing Address - Fax:317-297-4554
Practice Address - Street 1:3808 N LAWNDALE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2814
Practice Address - Country:US
Practice Address - Phone:317-297-4502
Practice Address - Fax:317-297-4554
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120078901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100071380AMedicaid