Healthcare Provider Details

I. General information

NPI: 1912090663
Provider Name (Legal Business Name): PLAINFIELD ORTHODONTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 DAN JONES ROAD
PLAINFIELD IN
46168
US

IV. Provider business mailing address

18 BOULEVARD MOTIF
BROWNSBURG IN
46112
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-6533
  • Fax: 317-852-3527
Mailing address:
  • Phone: 317-852-5566
  • Fax: 317-852-3527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12007457
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. PETER LESLIE CHAPMAN
Title or Position: PRESIDENT
Credential: D.D.S., M.S.D.
Phone: 317-852-5566