MEDICARE: ERIC T KAMMERER DDS 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	12009	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497243026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC T KAMMERER DDS PC

Provider Business Mailing Address
First Line	:	1754 N ARLINGTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-5126
Country	:	US
Telephone Number	:	317-356-2850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1754 N ARLINGTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-5126
Country	:	US
Telephone Number	:	317-356-2850
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ERIC T KAMMERER
Credential	:	DDS
Telephone Number	:	317-356-2850

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	04/30/2018

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