Provider Demographics
NPI:1316031743
Name:FISHERS DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:FISHERS DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-577-1911
Mailing Address - Street 1:11959 LAKESIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1316
Mailing Address - Country:US
Mailing Address - Phone:317-577-1911
Mailing Address - Fax:317-576-8070
Practice Address - Street 1:11959 LAKESIDE DRIVE
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1316
Practice Address - Country:US
Practice Address - Phone:317-577-1911
Practice Address - Fax:317-576-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008832261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental