Provider Demographics
NPI:1770744377
Name:INDIANAPOLIS ENDODONTICS, P.C.
Entity type:Organization
Organization Name:INDIANAPOLIS ENDODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPOLNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:317-924-3228
Mailing Address - Street 1:3750 GUION RD
Mailing Address - Street 2:SUITE #280
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-7602
Mailing Address - Country:US
Mailing Address - Phone:317-924-3228
Mailing Address - Fax:317-924-3737
Practice Address - Street 1:3750 GUION RD
Practice Address - Street 2:SUITE #280
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-7602
Practice Address - Country:US
Practice Address - Phone:317-924-3228
Practice Address - Fax:317-924-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN54000259A1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty