Healthcare Provider Details

I. General information

NPI: 1851311765
Provider Name (Legal Business Name): INDIANAPOLIS PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8433 HARCOURT RD SUITE 307
INDIANAPOLIS IN
46260-2190
US

IV. Provider business mailing address

8433 HARCOURT RD SUITE 307
INDIANAPOLIS IN
46260-2190
US

V. Phone/Fax

Practice location:
  • Phone: 317-872-7272
  • Fax:
Mailing address:
  • Phone: 317-872-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberBP8828735
License Number StateIN

VIII. Authorized Official

Name: DR. ERIN F PHILLIPS
Title or Position: DENTIST
Credential: DDS
Phone: 317-872-7272