Provider Demographics
NPI:1477997559
Name:BRAD SAMMONS DDS, PC
Entity Type:Organization
Organization Name:BRAD SAMMONS DDS, PC
Other - Org Name:BRAD SAMMONS DDS, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-859-6768
Mailing Address - Street 1:8325 S EMERSON AVE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8558
Mailing Address - Country:US
Mailing Address - Phone:317-859-6768
Mailing Address - Fax:317-859-0144
Practice Address - Street 1:8325 S EMERSON AVE
Practice Address - Street 2:SUITE A-1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8558
Practice Address - Country:US
Practice Address - Phone:317-859-6768
Practice Address - Fax:317-859-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty