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NPI Code Detail

MEDICARE: DENTAL PROFESSIONALS OF INDIANA, P.C.

MEDICARE: DENTAL PROFESSIONALS OF INDIANA, 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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1639864150
Entity Type Code : Organization
Provider Name (Legal Business Name) : DENTAL PROFESSIONALS OF INDIANA, P.C.
Provider Business Mailing Address
First Line : 8136 E SOUTHPORT RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46259-6806
Country : US
Telephone Number : 463-271-2550
Fax Number : 463-271-2554
Provider Business Practice Location Address
First Line : 8136 E SOUTHPORT RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46259-6806
Country : US
Telephone Number : 463-271-2550
Fax Number : 463-271-2554
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : BELINDA HUERTA
Credential :
Telephone Number : 217-540-2100
Provider Enumeration Date : 04/10/2023
Last Update Date : 04/10/2023

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Directions to “DENTAL PROFESSIONALS OF INDIANA, P.C. ” Practice Location

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