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General NPI Number Information
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NPI Number | 1992248058
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Entity Type | Organization
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Legal Business Name | PARKVIEW DENTAL
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 549 PARKVIEW DR.
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City | NEW WHITELAND
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State | IN
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Zip | 46184
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Country | US
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Telephone | 317-535-7522
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Fax | 317-535-5115
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Provider Business Mailing Address
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Address Line | 549 PARKVIEW DR
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City | NEW WHITELAND
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State | IN
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Zip | 46184-1365
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Country | US
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Telephone | 317-535-7522
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Fax | 317-535-5115
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CRYSTAL ROSS
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Credential |
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Telephone | 317-535-7522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12011888A
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License Number State | IN
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