Provider Demographics
NPI:1275630485
Name:ON-SITE DENTAL CARE, INC.
Entity Type:Organization
Organization Name:ON-SITE DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-337-0414
Mailing Address - Street 1:5729 W 85TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1330
Mailing Address - Country:US
Mailing Address - Phone:317-337-0414
Mailing Address - Fax:317-337-0423
Practice Address - Street 1:5729 W 85TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1330
Practice Address - Country:US
Practice Address - Phone:317-337-0414
Practice Address - Fax:317-337-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty