Provider Demographics
NPI:1295128213
Name:COMDENT, PC
Entity type:Organization
Organization Name:COMDENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT OF COMDENT, PC
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-783-9993
Mailing Address - Street 1:4200 S EAST ST
Mailing Address - Street 2:SUITE A-14
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1534
Mailing Address - Country:US
Mailing Address - Phone:317-783-9993
Mailing Address - Fax:317-783-9999
Practice Address - Street 1:4200 S EAST ST
Practice Address - Street 2:SUITE A-14
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1534
Practice Address - Country:US
Practice Address - Phone:317-783-9993
Practice Address - Fax:317-783-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120097191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200202580AMedicaid