Provider Demographics
NPI:1811737398
Name:LAFAYETTE DENTAL, LLC
Entity type:Organization
Organization Name:LAFAYETTE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIDDHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KSHATRIYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-414-5375
Mailing Address - Street 1:4031 WHITAKER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-2307
Mailing Address - Country:US
Mailing Address - Phone:662-414-5375
Mailing Address - Fax:
Practice Address - Street 1:3554 PROMENADE PKWY STE D
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-8418
Practice Address - Country:US
Practice Address - Phone:317-985-7363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental