Provider Demographics
NPI:1326170564
Name:LUMSDON, MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:LUMSDON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:EDMUND
Other - Last Name:GROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8936 SOUTHPOINTE DR
Mailing Address - Street 2:SUITE B 6
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-7506
Mailing Address - Country:US
Mailing Address - Phone:317-881-5200
Mailing Address - Fax:317-881-9255
Practice Address - Street 1:8936 SOUTHPOINTE DR
Practice Address - Street 2:SUITE B 6 CHOICE DENTAL CENTRE OF GREENWOOD PC
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7506
Practice Address - Country:US
Practice Address - Phone:317-881-5200
Practice Address - Fax:317-881-9255
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1611524OtherUNITED CONCORDIA