Healthcare Provider Details

I. General information

NPI: 1093977407
Provider Name (Legal Business Name): INDIANA ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8782 MADISON AVE
INDIANAPOLIS IN
46227-7202
US

IV. Provider business mailing address

8782 MADISON AVE
INDIANAPOLIS IN
46227-7202
US

V. Phone/Fax

Practice location:
  • Phone: 317-882-2882
  • Fax: 317-882-8986
Mailing address:
  • Phone: 317-882-2882
  • Fax: 317-882-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12009368
License Number StateIN

VIII. Authorized Official

Name: DR. DOUGLAS L RAMSEY
Title or Position: PRESIDENT
Credential: DDS
Phone: 317-882-2882