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General NPI Number Information
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NPI Number | 1528370681
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Entity Type | Organization
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Legal Business Name | CARMEL FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 370 MEDICAL DRIVE SUITE E
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City | CARMEL
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State | IN
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Zip | 46032
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Country | US
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Telephone | 317-575-0200
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Fax | 317-575-0202
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Provider Business Mailing Address
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Address Line | 370 MEDICAL DRIVE SUITE E
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City | CARMEL
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State | IN
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Zip | 43032
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Country | US
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Telephone | 317-575-0200
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSICA LYNN WORTHINGTON
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Credential | DMD
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Telephone | 317-575-0200
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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 | 12011279A
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License Number State | IN
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