Healthcare Provider Details

I. General information

NPI: 1790071918
Provider Name (Legal Business Name): KELLI ANNE HINDS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLI ANNE HINDS DDS

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 W 3RD ST
BLOOMINGTON IN
47404-4835
US

IV. Provider business mailing address

1016 NORTHLAKE CT
WAKE FOREST NC
27587-5382
US

V. Phone/Fax

Practice location:
  • Phone: 812-339-1671
  • Fax:
Mailing address:
  • Phone: 317-476-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12011647A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: