Provider Demographics
NPI:1184494098
Name:INDIANAPOLIS CENTER FOR IMPLANT AND COSMETIC DENTISTRY PC
Entity type:Organization
Organization Name:INDIANAPOLIS CENTER FOR IMPLANT AND COSMETIC DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-882-0228
Mailing Address - Street 1:7218 US 31
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-8539
Mailing Address - Country:US
Mailing Address - Phone:317-882-0228
Mailing Address - Fax:
Practice Address - Street 1:7218 US 31
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8539
Practice Address - Country:US
Practice Address - Phone:317-882-0228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANAPOLIS DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental