Provider Demographics
NPI:1780208884
Name:PROSTHODONTICS OF CENTRAL INDIANA
Entity Type:Organization
Organization Name:PROSTHODONTICS OF CENTRAL INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-574-0866
Mailing Address - Street 1:11405 N PENN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6905
Mailing Address - Country:US
Mailing Address - Phone:317-574-0866
Mailing Address - Fax:317-574-0867
Practice Address - Street 1:11405 N PENN ST STE 110
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6905
Practice Address - Country:US
Practice Address - Phone:317-574-0866
Practice Address - Fax:317-574-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty