Healthcare Provider Details

I. General information

NPI: 1417911975
Provider Name (Legal Business Name): BRUCE BRIAN HORSWELL MD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

1121 W MICHIGAN ST
INDIANAPOLIS IN
46202-5211
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-8300
  • Fax: 317-274-0965
Mailing address:
  • Phone: 317-274-7433
  • Fax: 317-274-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number12013297A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: