Provider Demographics
NPI:1619462090
Name:KIDS AND ADULTS DENTAL CARE INC
Entity Type:Organization
Organization Name:KIDS AND ADULTS DENTAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUPINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL NAGRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-480-0080
Mailing Address - Street 1:460 N MORTON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-1387
Mailing Address - Country:US
Mailing Address - Phone:317-480-0800
Mailing Address - Fax:
Practice Address - Street 1:460 N MORTON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-1387
Practice Address - Country:US
Practice Address - Phone:317-480-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1174965388Medicaid