Healthcare Provider Details

I. General information

NPI: 1720990328
Provider Name (Legal Business Name): IAN DAVID SPONSELLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2291 N MERIDIAN ST
INDIANAPOLIS IN
46208-5727
US

IV. Provider business mailing address

3115 N MERIDIAN ST APT H
INDIANAPOLIS IN
46208-5299
US

V. Phone/Fax

Practice location:
  • Phone: 317-926-5467
  • Fax:
Mailing address:
  • Phone: 812-483-4402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12015148A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: