Provider Demographics
NPI:1447415294
Name:GENERATIONS IN DENTISTRY PC
Entity Type:Organization
Organization Name:GENERATIONS IN DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEFLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-573-4000
Mailing Address - Street 1:13331 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3018
Mailing Address - Country:US
Mailing Address - Phone:317-573-4000
Mailing Address - Fax:317-573-4118
Practice Address - Street 1:13331 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3018
Practice Address - Country:US
Practice Address - Phone:317-573-4000
Practice Address - Fax:317-573-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008323A122300000X
IN120104078122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100389930Medicaid
IN1922112945OtherNPI
IN1215041231OtherNPI