MEDICARE: COMPLETE FAMILY DENTISTRY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1104836386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE FAMILY DENTISTRY, PC

Provider Business Mailing Address
First Line	:	2955 N HIGH SCHOOL RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-2915
Country	:	US
Telephone Number	:	317-293-4020
Fax Number	:	317-293-4064

Provider Business Practice Location Address
First Line	:	2955 N HIGH SCHOOL RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-2915
Country	:	US
Telephone Number	:	317-293-4020
Fax Number	:	317-293-4064

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREGORY A BIERMAN II
Credential	:
Telephone Number	:	317-293-4020

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/22/2020

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