MEDICARE: DR. GREGORY P. PFAU DDS

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	122300000X	Dentist	12007649	IN

General Provider Information

NPI Number	:	1457442352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY P. PFAU DDS

Provider Business Mailing Address
First Line	:	10571 PROPOSAL POINTE WAY
Second Line	:
City	:	FORTVILLE
State	:	IN
Zip	:	46040-8106
Country	:	US
Telephone Number	:	317-513-9883
Fax Number	:

Provider Business Practice Location Address
First Line	:	3915 MADISON AVE
Second Line	:	SUITE 2
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-1364
Country	:	US
Telephone Number	:	317-788-1001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	10/02/2008

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