Provider Demographics
NPI:1295060358
Name:DENTAL SLEEP MEDICINE OF INDIANA CORPORATION
Entity type:Organization
Organization Name:DENTAL SLEEP MEDICINE OF INDIANA CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-253-9111
Mailing Address - Street 1:5625 CASTLE CREEK PARKWAY NORTH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4304
Mailing Address - Country:US
Mailing Address - Phone:317-585-0008
Mailing Address - Fax:317-585-0006
Practice Address - Street 1:5625 CASTLE CREEK PARKWAY NORTH DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4304
Practice Address - Country:US
Practice Address - Phone:317-585-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6265070001Medicare NSC