MEDICARE: DOWNTOWN DENTAL GROUP, PC

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	1223G0001X	General Practice Dentistry	12009909	IN

General Provider Information

NPI Number	:	1134341332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOWNTOWN DENTAL GROUP, PC

Provider Business Mailing Address
First Line	:	201 N ILLINOIS ST
Second Line	:	SUITE 1770
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1904
Country	:	US
Telephone Number	:	317-237-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N ILLINOIS ST
Second Line	:	SUITE 1770
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1904
Country	:	US
Telephone Number	:	317-237-2225
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LUCI MORRISSEY
Credential	:
Telephone Number	:	317-237-2225

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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