=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154448868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOTT T. ROSENFELD, D.D.S., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8902 N MERIDIAN ST SUITE 237
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46260-5382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-846-6653
-----------------------------------------------------
Fax | 317-846-6675
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8902 N MERIDIAN ST SUITE 237
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46260-5382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-846-6653
-----------------------------------------------------
Fax | 317-846-6675
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, DENTIST
-----------------------------------------------------
Name | DR. SCOTT T. ROSENFELD
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 317-846-6653
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 12009525
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------