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General NPI Number Information
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NPI Number | 1265944938
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Entity Type | Organization
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Legal Business Name | BATH FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 11/02/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3410 N HIGH SCHOOL RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46224-1742
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Country | US
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Telephone | 317-987-5603
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Fax |
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Provider Business Mailing Address
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Address Line | 3410 N HIGH SCHOOL RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46224-1742
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Country | US
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Telephone | 317-987-5603
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | GAGANDEEP K BATH
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Credential | DDS,MSD
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Telephone | 317-987-5603
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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 | 12012382A
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License Number State | IN
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