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General NPI Number Information
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NPI Number | 1699211169
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Entity Type | Organization
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Legal Business Name | J. ORTHODONTICS INC
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 8071 TOWNSHIP LINE RD STE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2601
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Country | US
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Telephone | 317-731-5203
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Fax | 317-731-5748
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Provider Business Mailing Address
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Address Line | 8071 TOWNSHIP LINE RD STE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2601
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Country | US
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Telephone | 317-731-5203
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Fax | 317-731-5748
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMANTHA JONES
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Credential | D.D.S., M.S.D.
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Telephone | 317-731-5203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12010266A
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License Number State | IN
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