Healthcare Provider Details

I. General information

NPI: 1770744377
Provider Name (Legal Business Name): INDIANAPOLIS ENDODONTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/17/2008
Certification Date:
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: 317-924-3737
Mailing address:
  • Phone: 317-924-3228
  • Fax: 317-924-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number54000259A
License Number StateIN

VIII. Authorized Official

Name: KENNETH J SPOLNIK
Title or Position: PRESIDENT
Credential: D.D.S., M.S.D.
Phone: 317-924-3228