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General NPI Number Information
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NPI Number | 1942014725
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Entity Type | Organization
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Legal Business Name | MFDC OF INDIANA, INC
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 3804 N DELAWARE ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-2648
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Country | US
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Telephone | 463-258-7067
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 437169
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City | LOUISVILLE
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State | KY
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Zip | 40253-7169
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Country | US
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Telephone | 502-254-8500
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | JEFFREY REIBEL
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Credential |
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Telephone | 502-254-8526
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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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