Provider Demographics
NPI:1629703202
Name:KIDS & ADULT DENTISTRY INC
Entity Type:Organization
Organization Name:KIDS & ADULT DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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:317-828-0352
Mailing Address - Street 1:7214 MISTY WOODS LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9482
Mailing Address - Country:US
Mailing Address - Phone:317-828-0352
Mailing Address - Fax:
Practice Address - Street 1:7968 PENDLETON PIKE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-3957
Practice Address - Country:US
Practice Address - Phone:317-828-0352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental