Provider Demographics
NPI:1760546964
Name:KAMMERER, ERIC TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:TODD
Last Name:KAMMERER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 N ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-5126
Mailing Address - Country:US
Mailing Address - Phone:317-356-2850
Mailing Address - Fax:317-356-2850
Practice Address - Street 1:1754 N ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-5126
Practice Address - Country:US
Practice Address - Phone:317-356-2850
Practice Address - Fax:317-356-2850
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120094771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice