MEDICARE: VANCHIT JOHN D.D.S., M.S.D.

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	1223P0300X	Periodontics	12010162A	IN

General Provider Information

NPI Number	:	1790721991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANCHIT JOHN D.D.S., M.S.D.

Provider Business Mailing Address
First Line	:	3750 GUION RD
Second Line	:	#280
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-7602
Country	:	US
Telephone Number	:	317-396-1869
Fax Number	:	317-924-3737

Provider Business Practice Location Address
First Line	:	3750 GUION RD
Second Line	:	#280
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-7602
Country	:	US
Telephone Number	:	317-396-1869
Fax Number	:	317-924-3737

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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1154357978 — BENJAMIN H ADAMS D.D.S.,M.S.D.
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Practice Fax: 317-924-3737

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