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General NPI Number Information
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NPI Number | 1811737398
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Entity Type | Organization
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Legal Business Name | LAFAYETTE DENTAL, LLC
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 3554 PROMENADE PKWY STE D
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City | LAFAYETTE
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State | IN
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Zip | 47909-8418
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Country | US
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Telephone | 317-985-7363
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Fax |
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Provider Business Mailing Address
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Address Line | 4031 WHITAKER DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-2307
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Country | US
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Telephone | 662-414-5375
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | RIDDHI KSHATRIYA
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Credential |
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Telephone | 662-414-5375
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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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