Provider Demographics
NPI:1568892594
Name:10485 MICHIGAN ROAD DENTAL, LLC
Entity Type:Organization
Organization Name:10485 MICHIGAN ROAD DENTAL, LLC
Other - Org Name:NITETIME DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-875-7645
Mailing Address - Street 1:10485 N MICHIGAN RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7954
Mailing Address - Country:US
Mailing Address - Phone:317-875-7645
Mailing Address - Fax:317-875-7647
Practice Address - Street 1:10485 N MICHIGAN RD STE 150
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7954
Practice Address - Country:US
Practice Address - Phone:317-875-7645
Practice Address - Fax:317-875-7647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011892A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty