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General NPI Number Information
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NPI Number | 1548697592
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Entity Type | Organization
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Legal Business Name | HAMILTON COUNTY PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 10/06/2013
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Last Update Date | 10/06/2013
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Provider Practice Location Address
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Address Line | 14948 BEACON BLVD
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City | CARMEL
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State | IN
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Zip | 46032-5050
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Country | US
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Telephone | 317-965-8850
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Fax |
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Provider Business Mailing Address
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Address Line | 14948 BEACON BLVD
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City | CARMEL
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State | IN
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Zip | 46032-5050
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Country | US
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Telephone | 317-965-8850
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. LAURA JUNTGEN
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Credential | D.M.D.
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Telephone | 317-965-8850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12011451A
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License Number State | IN
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