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General NPI Number Information
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NPI Number | 1598158081
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Entity Type | Organization
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Legal Business Name | DENTAL PROFESSIONALS OF IN, P.C.
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 2145 W JONATHAN MOORE PIKE
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City | COLUMBUS
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State | IN
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Zip | 47201-9081
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Country | US
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Telephone | 812-618-9110
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Fax |
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Provider Business Mailing Address
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Address Line | 2145 W JONATHAN MOORE PIKE
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City | COLUMBUS
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State | IN
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Zip | 47201-9081
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Country | US
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Telephone | 812-618-9110
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | KELLI ELLSWORTH
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Credential |
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Telephone | 217-540-5152
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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 |
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License Number State |
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