MEDICARE: DCP OF INDIANA (LAFAYETTE SQUARE) PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223E0200X	Endodontics
3	1223G0001X	General Practice Dentistry
4	1223P0221X	Pediatric Dentistry
5	1223P0300X	Periodontics
6	1223P0700X	Prosthodontics
7	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1306817622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DCP OF INDIANA (LAFAYETTE SQUARE) PC

Provider Business Mailing Address
First Line	:	PO BOX 64-3011
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45264-0001
Country	:	US
Telephone Number	:	317-328-5905
Fax Number	:	317-328-8533

Provider Business Practice Location Address
First Line	:	4050 LAFAYETTE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-2527
Country	:	US
Telephone Number	:	317-328-5905
Fax Number	:	317-328-8533

Authorized Official
Title or Position	:	CHAIRMAN OF THE BOARD
Name	:	DR. ED MECKLER
Credential	:	D.D.S.
Telephone Number	:	800-487-4867

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	09/11/2025

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