Provider Demographics
NPI:1902367709
Name:ANDERSON WESTEND DENTAL LLC
Entity Type:Organization
Organization Name:ANDERSON WESTEND DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPT
Authorized Official - Middle Name:
Authorized Official - Last Name:RANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-369-7375
Mailing Address - Street 1:3611 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-2501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 W 9TH ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1436
Practice Address - Country:US
Practice Address - Phone:734-369-7375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1831486380OtherPROVIDER NPI