Provider Demographics
NPI:1295815835
Name:FISHERS PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:FISHERS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:RUMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-598-9898
Mailing Address - Street 1:9124 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3064
Mailing Address - Country:US
Mailing Address - Phone:317-598-9898
Mailing Address - Fax:317-596-9659
Practice Address - Street 1:9124 TECHNOLOGY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3064
Practice Address - Country:US
Practice Address - Phone:317-598-9898
Practice Address - Fax:317-596-9659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009305B1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty