Healthcare Provider Details

I. General information

NPI: 1689087116
Provider Name (Legal Business Name): EBISINDE MARIE AKAH D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 EDWARDS DR STE 124
PLAINFIELD IN
46168-2792
US

IV. Provider business mailing address

7638 DONNEHAN RD
INDIANAPOLIS IN
46217-7498
US

V. Phone/Fax

Practice location:
  • Phone: 614-592-1561
  • Fax:
Mailing address:
  • Phone: 614-592-1561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-024215
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12012774A
License Number StateIN

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: