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General NPI Number Information
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NPI Number | 1689165672
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Entity Type | Organization
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Legal Business Name | XU FAMILY DENTAL, LLC
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 828 FORT WAYNE AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-1309
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Country | US
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Telephone | 317-602-4898
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Fax | 317-559-7159
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Provider Business Mailing Address
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Address Line | 14536 STONEGATE CT
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City | CARMEL
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State | IN
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Zip | 46032-9132
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Country | US
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Telephone | 317-602-4898
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Fax | 317-559-7159
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. HAIFENG XU
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Credential | DDS, PHD
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Telephone | 317-602-4898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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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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