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General NPI Number Information
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NPI Number | 1356816037
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Entity Type | Organization
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Legal Business Name | WEST INDY PIPPIN DENTAL PC
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Dates
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Enumeration Date | 10/09/2018
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 8252 ROCKVILLE RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46214-3113
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Country | US
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Telephone | 317-352-2922
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Fax |
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Provider Business Mailing Address
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Address Line | 1090 NORTHCHASE PKWY SE STE 150
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City | MARIETTA
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State | GA
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Zip | 30067-6407
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Country | US
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Telephone | 770-916-5036
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Fax | 678-285-4760
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DALE MAYFIELD
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Credential | DMD
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Telephone | 770-916-5036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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