Provider Demographics
NPI:1922403922
Name:NAM PARK DENTAL PC
Entity Type:Organization
Organization Name:NAM PARK DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KASIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:NAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-257-3368
Mailing Address - Street 1:6117 N COLLEGE AVE STE 1&2
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2233
Mailing Address - Country:US
Mailing Address - Phone:317-257-3368
Mailing Address - Fax:
Practice Address - Street 1:6117 N COLLEGE AVE STE 1&2
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2233
Practice Address - Country:US
Practice Address - Phone:317-257-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120109431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty