Provider Demographics
NPI:1639492838
Name:CARMEL DENTAL GROUP
Entity Type:Organization
Organization Name:CARMEL DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOVDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-844-0022
Mailing Address - Street 1:715 W CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5806
Mailing Address - Country:US
Mailing Address - Phone:317-844-0022
Mailing Address - Fax:
Practice Address - Street 1:715 W CARMEL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5806
Practice Address - Country:US
Practice Address - Phone:317-844-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010707A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty