Provider Demographics
NPI:1497712772
Name:JAMESTOWNE DENTAL
Entity Type:Organization
Organization Name:JAMESTOWNE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LI
Authorized Official - Middle Name:CHUN
Authorized Official - Last Name:CHE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-789-1000
Mailing Address - Street 1:6249 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2091
Mailing Address - Country:US
Mailing Address - Phone:317-789-1000
Mailing Address - Fax:317-789-0001
Practice Address - Street 1:6249 S EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2091
Practice Address - Country:US
Practice Address - Phone:317-789-1000
Practice Address - Fax:317-789-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120107001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty