Provider Demographics
NPI:1689049173
Name:ASSOCIATES IN PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:ASSOCIATES IN PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-271-9727
Mailing Address - Street 1:7830 ROCKVILLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3129
Mailing Address - Country:US
Mailing Address - Phone:317-271-9727
Mailing Address - Fax:317-273-2376
Practice Address - Street 1:7830 ROCKVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3129
Practice Address - Country:US
Practice Address - Phone:317-271-9727
Practice Address - Fax:317-273-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007616261QD0000X
IN12008748261QD0000X
IN12008253261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100087220Medicaid
IN100130230Medicaid
IN100440160CMedicaid