Healthcare Provider Details

I. General information

NPI: 1437905841
Provider Name (Legal Business Name): RUGGS DANCY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5660 EDEN VILLAGE DR
INDIANAPOLIS IN
46254-1294
US

IV. Provider business mailing address

5660 EDEN VILLAGE DR
INDIANAPOLIS IN
46254-1294
US

V. Phone/Fax

Practice location:
  • Phone: 317-297-9750
  • Fax: 317-355-1505
Mailing address:
  • Phone: 317-297-9750
  • Fax: 317-355-1505

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: DR. SHIRA ESTHER RUGGS DANCY
Title or Position: OWNER
Credential: DDS
Phone: 317-679-7522