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General NPI Number Information
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NPI Number | 1386067627
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Entity Type | Organization
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Legal Business Name | GERMAN CHURCH RD FAMILY DENTISTRY
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Dates
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Enumeration Date | 01/22/2014
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 11020 E 10TH ST STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-3710
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Country | US
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Telephone | 317-898-9231
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Fax | 317-898-9245
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Provider Business Mailing Address
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Address Line | 11020 E 10TH ST STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-3710
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Country | US
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Telephone | 317-898-9231
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Fax | 317-898-9245
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DIANE COOMBS
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Credential |
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Telephone | 317-898-9231
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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 | 120111490A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12007959A
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License Number State | IN
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