Provider Demographics
NPI:1225286099
Name:WASHINGTON STREET DENTISTRY INC.
Entity Type:Organization
Organization Name:WASHINGTON STREET DENTISTRY INC.
Other - Org Name:WASHINGTON STREET DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:317-336-6723
Mailing Address - Street 1:10935 E WASHINGTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3181
Mailing Address - Country:US
Mailing Address - Phone:317-890-4435
Mailing Address - Fax:317-890-4460
Practice Address - Street 1:10935 E WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3181
Practice Address - Country:US
Practice Address - Phone:317-890-4435
Practice Address - Fax:317-890-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty