MEDICARE: KEVIN A DEARDORF D.D.S.,M.S.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	12008684A	IN

General Provider Information

NPI Number	:	1083655658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN A DEARDORF D.D.S.,M.S.D.

Provider Business Mailing Address
First Line	:	3750 GUION RD
Second Line	:	SUITE 280
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-7602
Country	:	US
Telephone Number	:	317-924-3228
Fax Number	:

Provider Business Practice Location Address
First Line	:	3750 GUION RD
Second Line	:	SUITE 280
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-7602
Country	:	US
Telephone Number	:	317-924-3228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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