Provider Demographics
NPI:1356813935
Name:RED HAT NEIGHBORHOOD DENTIST
Entity Type:Organization
Organization Name:RED HAT NEIGHBORHOOD DENTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:POWER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-847-9455
Mailing Address - Street 1:5869 LAWTON LOOP EAST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-1064
Mailing Address - Country:US
Mailing Address - Phone:317-847-9455
Mailing Address - Fax:
Practice Address - Street 1:5719 LAWTON LOOP EAST DR STE 2
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2322
Practice Address - Country:US
Practice Address - Phone:317-847-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental