Provider Demographics
NPI:1255837860
Name:HAMILTON COUNTY DENTAL
Entity Type:Organization
Organization Name:HAMILTON COUNTY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:THURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-842-8453
Mailing Address - Street 1:9885 E 116TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9242
Mailing Address - Country:US
Mailing Address - Phone:317-842-8453
Mailing Address - Fax:317-842-8741
Practice Address - Street 1:11630 OLIO RD STE 100
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7678
Practice Address - Country:US
Practice Address - Phone:317-288-4226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010349A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherTIN