Healthcare Provider Details

I. General information

NPI: 1902963507
Provider Name (Legal Business Name): CARL LERNER D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8937 SOUTHPOINTE DR SUITE A-2
INDIANAPOLIS IN
46227-1086
US

IV. Provider business mailing address

8937 SOUTHPOINTE DR SUITE A-2
INDIANAPOLIS IN
46227-1086
US

V. Phone/Fax

Practice location:
  • Phone: 317-300-0535
  • Fax: 317-300-0691
Mailing address:
  • Phone: 317-300-0535
  • Fax: 317-300-0691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number12009129A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: