MEDICARE: MARCIA A SODER 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	1223G0001X	General Practice Dentistry	12008734	IN

General Provider Information

NPI Number	:	1679585244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA A SODER DDS

Provider Business Mailing Address
First Line	:	6002 W 62ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-2909
Country	:	US
Telephone Number	:	317-293-5011
Fax Number	:	317-291-7693

Provider Business Practice Location Address
First Line	:	6002 W 62ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-2909
Country	:	US
Telephone Number	:	317-293-5011
Fax Number	:	317-291-7693

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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