Healthcare Provider Details

I. General information

NPI: 1659938595
Provider Name (Legal Business Name): MICHAEL WIREY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 NAAB RD STE 355
INDIANAPOLIS IN
46260-1987
US

IV. Provider business mailing address

8240 NAAB RD STE 355
INDIANAPOLIS IN
46260-1987
US

V. Phone/Fax

Practice location:
  • Phone: 317-876-1095
  • Fax: 317-875-7275
Mailing address:
  • Phone: 317-876-1095
  • Fax: 317-875-7275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number12013162A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12013162A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: