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General NPI Number Information
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NPI Number | 1407199342
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Entity Type | Organization
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Legal Business Name | SIMPLY DENTAL OF FISHERS PC
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 11876 OLIO RD STE 300
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City | FISHERS
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State | IN
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Zip | 46037-9767
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Country | US
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Telephone | 317-570-2777
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Fax | 317-570-2990
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Provider Business Mailing Address
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Address Line | 11876 OLIO RD STE 300
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City | FISHERS
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State | IN
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Zip | 46037-9767
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Country | US
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Telephone | 317-570-2777
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Fax | 317-570-2990
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN SCOTT CLAUSS
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Credential | DDS
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Telephone | 317-570-2777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12009552A
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License Number State | IN
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