Healthcare Provider Details

I. General information

NPI: 1366066375
Provider Name (Legal Business Name): JINDAL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 08/14/2021
Certification Date: 08/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N WEINBACH AVE STE 910
EVANSVILLE IN
47711-6607
US

IV. Provider business mailing address

701 N WEINBACH AVE STE 910
EVANSVILLE IN
47711-6607
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-2836
  • Fax:
Mailing address:
  • Phone: 812-477-2836
  • Fax: 812-477-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADITI JINDAL
Title or Position: DIRECTOR
Credential:
Phone: 314-223-2450