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General NPI Number Information
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NPI Number | 1366489627
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY WEST, LLC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8930 W 10TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46234-2132
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Country | US
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Telephone | 317-271-6060
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Fax | 317-271-6065
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Provider Business Mailing Address
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Address Line | 8930 W 10TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46234-2132
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Country | US
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Telephone | 317-271-6060
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Fax | 317-271-6065
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. MARK I THOMPSON
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Credential | D.D.S.
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Telephone | 317-271-6060
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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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