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General NPI Number Information
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NPI Number | 1013166941
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Entity Type | Organization
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Legal Business Name | CASTLETON GENERAL & IMPLANT DENTISTRY PC
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 6535 E 82ND ST SUITE 211
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-4524
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Country | US
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Telephone | 317-849-3597
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Fax | 317-913-0641
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Provider Business Mailing Address
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Address Line | 6535 E 82ND ST SUITE 211
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-4524
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Country | US
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Telephone | 317-849-3597
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Fax | 317-913-0641
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Authorized Official
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Title or Position | OWNER
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Name | DR. LUCAS B MARRS
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Credential | DDS
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Telephone | 317-849-3597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12011157A
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License Number State | IN
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