Provider Demographics
NPI:1407199342
Name:SIMPLY DENTAL OF FISHERS PC
Entity Type:Organization
Organization Name:SIMPLY DENTAL OF FISHERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CLAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-570-2777
Mailing Address - Street 1:11876 OLIO RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9767
Mailing Address - Country:US
Mailing Address - Phone:317-570-2777
Mailing Address - Fax:317-570-2990
Practice Address - Street 1:11876 OLIO RD STE 300
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9767
Practice Address - Country:US
Practice Address - Phone:317-570-2777
Practice Address - Fax:317-570-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009552A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty