Healthcare Provider Details

I. General information

NPI: 1376837070
Provider Name (Legal Business Name): STEELE PEDIATRIC DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9602 E WASHINGTON ST STE C
INDIANAPOLIS IN
46229-3060
US

IV. Provider business mailing address

9602 E WASHINGTON ST STE C
INDIANAPOLIS IN
46229-3060
US

V. Phone/Fax

Practice location:
  • Phone: 317-899-5437
  • Fax: 317-897-0771
Mailing address:
  • Phone: 317-899-5437
  • Fax: 317-897-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12010792A
License Number StateIN

VIII. Authorized Official

Name: DR. JAIME LYN STEELE
Title or Position: PEDIATRIC DENTIST
Credential: D.D.S.
Phone: 317-517-7620