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General NPI Number Information
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NPI Number | 1942676242
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Entity Type | Organization
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Legal Business Name | NORTHEAST DENTAL CARE LLC
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 6132 ALLISONVILLE RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-4608
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Country | US
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Telephone | 317-259-7310
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Fax | 317-259-7321
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Provider Business Mailing Address
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Address Line | 6132 ALLISONVILLE RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-4608
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Country | US
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Telephone | 317-259-7310
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Fax | 317-259-7321
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Authorized Official
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Title or Position | PRINCIPAL MEMBER
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Name | DR. JEROME CURETON
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Credential | DDS
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Telephone | 317-989-5534
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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 | 12009713
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License Number State | IN
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