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General NPI Number Information
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NPI Number | 1013427350
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Entity Type | Organization
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Legal Business Name | THOMAN DENTAL LLC
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Dates
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Enumeration Date | 09/30/2017
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Last Update Date | 09/30/2017
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Provider Practice Location Address
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Address Line | 4950 E STOP 11 RD STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-9104
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Country | US
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Telephone | 317-865-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 32 N MAIN ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-5136
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Country | US
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Telephone | 317-788-1300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAROLE E THOMAN
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Credential |
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Telephone | 317-788-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12008095
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License Number State | IN
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