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General NPI Number Information
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NPI Number | 1184232340
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Entity Type | Individual
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Provider Name | SEGHEN AMANIOS
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Gender | Female
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 5330 W WASHINGTON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46241-2147
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Country | US
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Telephone | 317-243-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 1552 RED DUNES RUN
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City | AVON
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State | IN
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Zip | 46123-6404
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019.032701
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2020023698
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12013570A
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License Number State | IN
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