Healthcare Provider Details

I. General information

NPI: 1932321437
Provider Name (Legal Business Name): DENTAL PROFESSIONALS OF INDIANA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 LAFOLLETTE STA N
FLOYDS KNOBS IN
47119-9780
US

IV. Provider business mailing address

411 LAFOLLETTE STATION N.
FLOYDS KNOBS IN
47119-9780
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-8871
  • Fax: 812-923-8872
Mailing address:
  • Phone: 812-923-8871
  • Fax: 812-923-8872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HOELSCHER
Title or Position: INSURANCE/CREDENTIALING
Credential:
Phone: 217-540-5100