Healthcare Provider Details

I. General information

NPI: 1417118969
Provider Name (Legal Business Name): SANDERS WEDDELL PEDIATRIC DENTAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14555 HAZEL DELL PKWY SUITE 100
CARMEL IN
46033-7000
US

IV. Provider business mailing address

14555 HAZEL DELL PKWY SUITE 100
CARMEL IN
46033-7000
US

V. Phone/Fax

Practice location:
  • Phone: 317-816-1555
  • Fax:
Mailing address:
  • Phone: 317-816-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12009323
License Number StateIN

VIII. Authorized Official

Name: DR. BRIAN J SANDERS
Title or Position: OWNER
Credential: DDS
Phone: 317-816-1555