Provider Demographics
NPI:1134720147
Name:MS VIBBERT DDS PC
Entity type:Organization
Organization Name:MS VIBBERT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OM
Authorized Official - Prefix:
Authorized Official - First Name:AMADNA
Authorized Official - Middle Name:
Authorized Official - Last Name:V
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:131-780-2064
Mailing Address - Street 1:7301 GEORGETOWN RD STE 113
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-4157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7301 GEORGETOWN RD STE 113
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-4157
Practice Address - Country:US
Practice Address - Phone:317-802-0649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental