Provider Demographics
NPI:1487190542
Name:ELSNER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:ELSNER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:ELSNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-896-1986
Mailing Address - Street 1:16411 SOUTHPARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8468
Mailing Address - Country:US
Mailing Address - Phone:317-896-1986
Mailing Address - Fax:317-896-1886
Practice Address - Street 1:16411 SOUTHPARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8468
Practice Address - Country:US
Practice Address - Phone:317-896-1986
Practice Address - Fax:317-896-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011951A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty