Healthcare Provider Details

I. General information

NPI: 1588964589
Provider Name (Legal Business Name): JMH DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10485 N MICHIGAN RD
CARMEL IN
46032-7942
US

IV. Provider business mailing address

10485 N MICHIGAN RD
CARMEL IN
46032-7942
US

V. Phone/Fax

Practice location:
  • Phone: 317-875-7645
  • Fax:
Mailing address:
  • Phone: 317-875-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12009335
License Number StateIN

VIII. Authorized Official

Name: DENISE BEVER
Title or Position: EXECUTIVE MANAGER
Credential:
Phone: 317-875-7645