Healthcare Provider Details

I. General information

NPI: 1235788860
Provider Name (Legal Business Name): ENJOY DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 N COLLEGE AVE
INDIANAPOLIS IN
46202-3468
US

IV. Provider business mailing address

818 N COLLEGE AVE
INDIANAPOLIS IN
46202-3468
US

V. Phone/Fax

Practice location:
  • Phone: 317-296-3399
  • Fax:
Mailing address:
  • Phone: 317-296-3399
  • Fax: 317-896-0478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MOHLER
Title or Position: DENTIST/OWNER
Credential:
Phone: 317-296-3399