Healthcare Provider Details

I. General information

NPI: 1447330352
Provider Name (Legal Business Name): JOHN H. SEXAUER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 W 10TH ST
INDIANAPOLIS IN
46214-6500
US

IV. Provider business mailing address

240 VERNON LN
BROWNSBURG IN
46112-1347
US

V. Phone/Fax

Practice location:
  • Phone: 317-241-0080
  • Fax:
Mailing address:
  • Phone: 317-852-6075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12008328A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: