Provider Demographics
NPI:1467674978
Name:DENTAL PROFESSIONALS OF INDIANA, P.C.
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF INDIANA, P.C.
Other - Org Name:EAGLE CREEK DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COOD
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOELSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:6920 PARKDALE PLACE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254
Mailing Address - Country:US
Mailing Address - Phone:317-329-7170
Mailing Address - Fax:317-329-7372
Practice Address - Street 1:6920 PARKDALE PLACE
Practice Address - Street 2:SUITE 111
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254
Practice Address - Country:US
Practice Address - Phone:317-329-7170
Practice Address - Fax:317-329-7372
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF INDIANA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty