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General NPI Number Information
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NPI Number | 1407996291
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Entity Type | Organization
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Legal Business Name | UNIVERSITY DENTAL SERVICE PLAN INC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 04/30/2010
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Provider Practice Location Address
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Address Line | 1121 W MICHIGAN ST ROOM 285B
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5211
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Country | US
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Telephone | 317-278-6946
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Fax | 317-274-6583
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Provider Business Mailing Address
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Address Line | 1121 W MICHIGAN ST ROOM 285B
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5211
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Country | US
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Telephone | 317-278-6946
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Fax | 317-284-6583
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Authorized Official
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Title or Position | CLINIC ADMINSTRATOR
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Name | MS. JILL ALLEN
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Credential |
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Telephone | 317-278-6946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #5
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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 #6
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #9
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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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