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General NPI Number Information
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NPI Number | 1033309471
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Entity Type | Organization
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Legal Business Name | KEYSTONE ENDODONTICS
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 3105 E 98TH ST SUITE 130
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City | INDIANAPOLIS
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State | IN
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Zip | 46280-2005
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Country | US
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Telephone | 317-569-9977
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Fax |
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Provider Business Mailing Address
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Address Line | 3105 E 98TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46280-2005
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Country | US
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Telephone | 317-569-9977
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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. DONALD G. ANDERSON I
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Credential | D.D.S.,M.S.
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Telephone | 317-569-9977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 12009805
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License Number State | IN
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