Healthcare Provider Details

I. General information

NPI: 1326403221
Provider Name (Legal Business Name): CARMEL PEDIATRIC DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12174 N MERIDIAN ST STE 200
CARMEL IN
46032-4578
US

IV. Provider business mailing address

12174 N MERIDIAN ST STE 200
CARMEL IN
46032-4578
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-3496
  • Fax: 317-846-4497
Mailing address:
  • Phone: 317-846-3496
  • Fax: 317-846-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHERINE T NICHOLS
Title or Position: PEDIATRIC DENTIST
Credential: DDS
Phone: 317-846-3496