Provider Demographics
NPI:1497243026
Name:ERIC T KAMMERER DDS PC
Entity Type:Organization
Organization Name:ERIC T KAMMERER DDS PC
Other - Org Name:ERIC T. KAMMERER, D.D.S., PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAMMERER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-356-2850
Mailing Address - Street 1:1754 N ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-5126
Mailing Address - Country:US
Mailing Address - Phone:317-356-2850
Mailing Address - Fax:
Practice Address - Street 1:1754 N ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-5126
Practice Address - Country:US
Practice Address - Phone:317-356-2850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERIC T KRAMMERER DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100121850AMedicaid