Healthcare Provider Details

I. General information

NPI: 1548339823
Provider Name (Legal Business Name): DAVID GORIS, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S EMERSON AVE STE 130
GREENWOOD IN
46143-1916
US

IV. Provider business mailing address

1550 REDSUNSET DR
BROWNSBURG IN
46112-7734
US

V. Phone/Fax

Practice location:
  • Phone: 317-888-4044
  • Fax: 317-888-4073
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010322
License Number StateIN

VIII. Authorized Official

Name: DAVID GORIS
Title or Position: OWNER
Credential: D.D.S.
Phone: 317-888-4044