Provider Demographics
NPI:1962502146
Name:COMPLETE DENTAL CARE OF AVON P.C.
Entity Type:Organization
Organization Name:COMPLETE DENTAL CARE OF AVON P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:MENEGOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PROSTHODONTIST
Authorized Official - Phone:317-271-3079
Mailing Address - Street 1:10740 E US HIGHWAY 36
Mailing Address - Street 2:A
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7982
Mailing Address - Country:US
Mailing Address - Phone:317-271-3079
Mailing Address - Fax:317-271-2574
Practice Address - Street 1:10740 E US HIGHWAY 36
Practice Address - Street 2:A
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7982
Practice Address - Country:US
Practice Address - Phone:317-271-3079
Practice Address - Fax:317-271-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120098261223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty