Provider Demographics
NPI:1972704716
Name:ZIONSVILLE PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:ZIONSVILLE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANNEKEFFER
Authorized Official - Last Name:MCHENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MSD
Authorized Official - Phone:317-873-4186
Mailing Address - Street 1:55 BRENDON WAY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1961
Mailing Address - Country:US
Mailing Address - Phone:317-873-4186
Mailing Address - Fax:317-873-1034
Practice Address - Street 1:55 BRENDON WAY
Practice Address - Street 2:SUITE 500
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1961
Practice Address - Country:US
Practice Address - Phone:317-873-4186
Practice Address - Fax:317-873-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010176A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty