Healthcare Provider Details

I. General information

NPI: 1598910598
Provider Name (Legal Business Name): BETWEEN THE CHEEKS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 LAFAYETTE RD
INDIANAPOLIS IN
46254-1620
US

IV. Provider business mailing address

5470 LAFAYETTE RD
INDIANAPOLIS IN
46254-1620
US

V. Phone/Fax

Practice location:
  • Phone: 317-293-4611
  • Fax: 317-297-7504
Mailing address:
  • Phone: 317-293-4611
  • Fax: 317-297-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12010288A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26019790A
License Number StateIN

VIII. Authorized Official

Name: MR. DAVID WESLEY MILLER
Title or Position: CHIEF OPERATING OFFICER
Credential: R.PH.
Phone: 317-293-4611