Provider Demographics
NPI:1184294837
Name:INDY DENTAL HEALTH-SHELBYVILLE
Entity type:Organization
Organization Name:INDY DENTAL HEALTH-SHELBYVILLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:317-872-3465
Mailing Address - Street 1:9333 N MERIDIAN ST STE 225
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1837
Mailing Address - Country:US
Mailing Address - Phone:317-872-3465
Mailing Address - Fax:
Practice Address - Street 1:122 LEE BLVD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-3403
Practice Address - Country:US
Practice Address - Phone:317-398-6399
Practice Address - Fax:317-398-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental