Healthcare Provider Details

I. General information

NPI: 1316984669
Provider Name (Legal Business Name): HENNETTE & KLEIN D.D.S.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7830 ROCKVILLE RD
INDIANAPOLIS IN
46214-3129
US

IV. Provider business mailing address

7830 ROCKVILLE RD
INDIANAPOLIS IN
46214-3129
US

V. Phone/Fax

Practice location:
  • Phone: 317-271-9727
  • Fax: 317-273-2373
Mailing address:
  • Phone: 317-271-9727
  • Fax: 317-273-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12008107A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12008394A
License Number StateIN

VIII. Authorized Official

Name: DR. JOHN D. HENNETTE
Title or Position: PRESIDENT
Credential: DDS
Phone: 317-271-9727