Provider Demographics
NPI:1780380915
Name:INFUSE DENTAL LLC
Entity type:Organization
Organization Name:INFUSE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHESHWARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:270-993-8362
Mailing Address - Street 1:5521 W LINCOLN HWY STE 215
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1098
Mailing Address - Country:US
Mailing Address - Phone:219-472-0042
Mailing Address - Fax:219-472-0023
Practice Address - Street 1:5521 W LINCOLN HWY STE 215
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1098
Practice Address - Country:US
Practice Address - Phone:219-472-0042
Practice Address - Fax:219-472-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental