MEDICARE: INDUS DENTAL ASSOCIATES, P.C.

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	:	1215300967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDUS DENTAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	15110 DALLAS PKWY
Second Line	:	SUITE 470
City	:	DALLAS
State	:	TX
Zip	:	75248-4635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 S HAMPTON RD
Second Line	:	SUITE 201
City	:	DALLAS
State	:	TX
Zip	:	75224-2367
Country	:	US
Telephone Number	:	469-608-8327
Fax Number	:

Authorized Official
Title or Position	:	DENTAL DIRECTOR/ OWNER
Name	:	HARRY J BLANEK
Credential	:	D.D.S.
Telephone Number	:	469-608-8327

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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