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General NPI Number Information
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NPI Number | 1306389267
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTAL CENTER
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 9885 E 116TH ST STE 100
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City | FISHERS
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State | IN
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Zip | 46037-9241
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Country | US
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Telephone | 317-842-8453
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Fax | 317-842-8741
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Provider Business Mailing Address
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Address Line | 9885 E 116TH ST STE 100
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City | FISHERS
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State | IN
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Zip | 46037-9241
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Country | US
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Telephone | 317-842-8453
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Fax | 317-842-8741
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Authorized Official
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Title or Position | DENTIST
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Name | MRS. MICHELLE H EDWARDS
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Credential | DDS
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Telephone | 317-842-8453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12010350A
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License Number State | IN
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