Healthcare Provider Details

I. General information

NPI: 1780597955
Provider Name (Legal Business Name): LWIN MOE AUNG BDS, MS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 W MICHIGAN ST
INDIANAPOLIS IN
46202-5211
US

IV. Provider business mailing address

1667 FETKE DR
SAINT JOSEPH MI
49085-8618
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-1037
  • Fax:
Mailing address:
  • Phone: 269-313-5324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberLDR260377
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: