Provider Demographics
NPI:1639689987
Name:PARADOX DENTAL LLC
Entity Type:Organization
Organization Name:PARADOX DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-788-1300
Mailing Address - Street 1:32 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5136
Mailing Address - Country:US
Mailing Address - Phone:317-788-1300
Mailing Address - Fax:
Practice Address - Street 1:4950 E STOP 11 RD STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9104
Practice Address - Country:US
Practice Address - Phone:317-865-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-01
Last Update Date:2017-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008941261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental