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General NPI Number Information
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NPI Number | 1356707210
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Entity Type | Organization
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Legal Business Name | INDIANA DENTURE SPECIALIST, INC
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 5510 S EAST ST STE C
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-1939
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Country | US
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Telephone | 317-782-3362
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Fax | 317-879-5385
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Provider Business Mailing Address
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Address Line | 5510 S EAST ST STE C
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-1939
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Country | US
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Telephone | 317-782-3362
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Fax | 317-879-5385
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CURTIS L EAKER
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Credential |
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Telephone | 317-782-3362
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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 | 12009983
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License Number State |
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