Provider Demographics
NPI:1255082178
Name:CORNERSTONE WEST LLC
Entity type:Organization
Organization Name:CORNERSTONE WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER/ DDS
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-897-8970
Mailing Address - Street 1:1201 N POST RD STE 6
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4225
Mailing Address - Country:US
Mailing Address - Phone:317-897-8970
Mailing Address - Fax:
Practice Address - Street 1:157 MEADOW DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1413
Practice Address - Country:US
Practice Address - Phone:317-745-5497
Practice Address - Fax:317-745-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental