Provider Demographics
NPI:1427583103
Name:IMMEDIADENT OF INDIANA, P.C.
Entity Type:Organization
Organization Name:IMMEDIADENT OF INDIANA, P.C.
Other - Org Name:IMMEDIADENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-428-1684
Mailing Address - Street 1:PO BOX 11568
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-4268
Mailing Address - Country:US
Mailing Address - Phone:913-428-1686
Mailing Address - Fax:866-591-0604
Practice Address - Street 1:6150 E 82ND ST # 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1500
Practice Address - Country:US
Practice Address - Phone:913-428-1684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty