Provider Demographics
NPI:1346574647
Name:DENTAL PROFESSIONALS OF INDIANA, P.C.
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF INDIANA, P.C.
Other - Org Name:INDIANAPOLIS DENTAL DESIGNS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5699
Mailing Address - Street 1:8801 N MERIDIAN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2396
Mailing Address - Country:US
Mailing Address - Phone:317-575-6100
Mailing Address - Fax:
Practice Address - Street 1:8801 N MERIDIAN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2396
Practice Address - Country:US
Practice Address - Phone:317-575-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF INDIANA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-21
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty