Healthcare Provider Details

I. General information

NPI: 1215117452
Provider Name (Legal Business Name): JOSEF MA KARLOS SANTOS BRINGAS DMD, DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 GUION RD SUITE 280
INDIANAPOLIS IN
46222-7602
US

IV. Provider business mailing address

3750 GUION RD SUITE 280
INDIANAPOLIS IN
46222-7602
US

V. Phone/Fax

Practice location:
  • Phone: 317-924-3228
  • Fax:
Mailing address:
  • Phone: 317-924-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12012071A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: