Healthcare Provider Details

I. General information

NPI: 1942529128
Provider Name (Legal Business Name): LAURA MICHELLE JUNTGEN D.M.D., MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 NORTH MERIDIAN STREET SUITE 165
CARMEL IN
46032
US

IV. Provider business mailing address

13430 NORTH MERIDIAN STREET SUITE 165
CARMEL IN
46032
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-5893
  • Fax: 317-484-6587
Mailing address:
  • Phone: 317-846-5893
  • Fax: 317-484-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12011451A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: