Provider Demographics
NPI:1649659913
Name:SINNIS FAMILY DENTAL, INC.
Entity type:Organization
Organization Name:SINNIS FAMILY DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-547-1111
Mailing Address - Street 1:6998 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-1105
Mailing Address - Country:US
Mailing Address - Phone:317-547-1111
Mailing Address - Fax:317-547-1141
Practice Address - Street 1:6998 E 30TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1105
Practice Address - Country:US
Practice Address - Phone:317-547-1111
Practice Address - Fax:317-547-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009597A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200255930Medicaid
IN200255930AMedicaid