Provider Demographics
NPI:1558785709
Name:PLAINFIELD DENTAL
Entity Type:Organization
Organization Name:PLAINFIELD DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:KINGSEED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-318-3151
Mailing Address - Street 1:824 EDWARDS DR
Mailing Address - Street 2:UNIT 124
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2791
Mailing Address - Country:US
Mailing Address - Phone:317-268-4593
Mailing Address - Fax:
Practice Address - Street 1:824 EDWARDS DR
Practice Address - Street 2:UNIT 124
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2791
Practice Address - Country:US
Practice Address - Phone:317-268-4593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-08
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011426A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty