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General NPI Number Information
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NPI Number | 1801649637
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Entity Type | Organization
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Legal Business Name | EASTPOINTE FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 1002 N MITTHOEFER RD STE B
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-2461
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Country | US
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Telephone | 317-898-6666
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Fax | 317-898-4965
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Provider Business Mailing Address
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Address Line | 1002 N MITTHOEFER RD STE B
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-2461
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Country | US
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Telephone | 317-898-6666
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Fax | 317-898-4965
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Authorized Official
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Title or Position | OWNER / DENTIST
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Name | AMANDA MARIE CLEMONS
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Credential | DDS
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Telephone | 317-502-4558
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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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