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General NPI Number Information
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NPI Number | 1477979300
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Entity Type | Organization
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Legal Business Name | GARY L LLEWELLYN DDS LLC
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 6211 W 30TH ST G
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City | INDIANAPOLIS
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State | IN
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Zip | 46224-3048
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Country | US
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Telephone | 317-291-7550
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Fax | 317-291-1746
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Provider Business Mailing Address
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Address Line | 6211 W 30TH ST STE G
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City | INDIANAPOLIS
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State | IN
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Zip | 46224-3057
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Country | US
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Telephone | 317-291-7550
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Fax | 317-291-1746
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Authorized Official
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Title or Position | OWNER
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Name | GARY L LLEWELLYN
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Credential | DDS
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Telephone | 317-291-7550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 12008920
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License Number State | IN
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