Provider Demographics
NPI:1306389267
Name:CHILDREN'S DENTAL CENTER
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:H
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-842-8453
Mailing Address - Street 1:9885 E 116TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9241
Mailing Address - Country:US
Mailing Address - Phone:317-842-8453
Mailing Address - Fax:317-842-8741
Practice Address - Street 1:9885 E 116TH ST
Practice Address - Street 2:STE 100
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9241
Practice Address - Country:US
Practice Address - Phone:317-842-8453
Practice Address - Fax:317-842-8741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010350A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental