Healthcare Provider Details

I. General information

NPI: 1962173575
Provider Name (Legal Business Name): YEPES DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13760 LAKERIDGE DR
FISHERS IN
46037-7608
US

IV. Provider business mailing address

13760 LAKERIDGE DR
FISHERS IN
46037-7608
US

V. Phone/Fax

Practice location:
  • Phone: 317-597-0184
  • Fax: 317-932-5978
Mailing address:
  • Phone: 317-597-0184
  • Fax: 317-932-5978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALONDRA CAMACHO
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 317-597-0184