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General NPI Number Information
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NPI Number | 1235741083
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Entity Type | Individual
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Provider Name | MRS. MARYCARMEN CARPIO HERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 3636 E 38TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46218-1454
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Country | US
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Telephone | 317-743-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 1967 N COUNTY ROAD 100 E
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City | DANVILLE
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State | IN
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Zip | 46122-8309
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Country | US
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Telephone | 317-946-0703
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12013447A
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License Number State | IN
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