Healthcare Provider Details

I. General information

NPI: 1154656775
Provider Name (Legal Business Name): MAUPIN FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 WEST MAIN STREET SUITE 151
PLAINFIELD IN
46168-9704
US

IV. Provider business mailing address

4877 MYRTLE LN
GREENWOOD IN
46142-9200
US

V. Phone/Fax

Practice location:
  • Phone: 317-838-7100
  • Fax: 317-885-0417
Mailing address:
  • Phone: 317-340-3804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010749A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. HEATHER ANN MAUPIN
Title or Position: PRESIDENT
Credential: DDS
Phone: 317-838-7100