Provider Demographics
NPI:1689165672
Name:XU FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:XU FAMILY DENTAL, LLC
Other - Org Name:CARE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAIFENG
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:317-602-4898
Mailing Address - Street 1:14536 STONEGATE CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9132
Mailing Address - Country:US
Mailing Address - Phone:317-602-4898
Mailing Address - Fax:317-559-7159
Practice Address - Street 1:828 FORT WAYNE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1309
Practice Address - Country:US
Practice Address - Phone:317-602-4898
Practice Address - Fax:317-559-7159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201283020Medicaid