Provider Demographics
NPI:1720693401
Name:SAMELA FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:SAMELA FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LAMONT
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:317-450-4899
Mailing Address - Street 1:11934 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-0110
Mailing Address - Country:US
Mailing Address - Phone:317-450-4899
Mailing Address - Fax:
Practice Address - Street 1:1678 FRY RD STE B
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1176
Practice Address - Country:US
Practice Address - Phone:314-360-8443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental