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General NPI Number Information
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NPI Number | 1639025638
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Entity Type | Organization
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Legal Business Name | HOOSIER DENTAL IN LLC
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Dates
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Enumeration Date | 03/10/2026
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 10820 PENDLETON PIKE STE B
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City | INDIANAPOLIS
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State | IN
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Zip | 46236-2952
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Country | US
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Telephone | 317-597-0184
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 W END AVE STE 410
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City | NASHVILLE
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State | TN
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Zip | 37203-2590
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUAN YEPES
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Credential |
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Telephone | 317-938-1181
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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 |
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License Number State |
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