Provider Demographics
NPI:1629189865
Name:ALEX M. MISHEL DDS P.C.
Entity Type:Organization
Organization Name:ALEX M. MISHEL DDS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:M
Authorized Official - Last Name:MISHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-255-2941
Mailing Address - Street 1:6100 N. KEYSTONE AVE.
Mailing Address - Street 2:SUITE 215
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2426
Mailing Address - Country:US
Mailing Address - Phone:317-255-2941
Mailing Address - Fax:317-255-1656
Practice Address - Street 1:6100 N. KEYSTONE AVE.
Practice Address - Street 2:SUITE 215
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2426
Practice Address - Country:US
Practice Address - Phone:317-255-2941
Practice Address - Fax:317-255-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009382A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty