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NPI Code Detail

MEDICARE: DR. THANH QUACH D.D.S.

MEDICARE: DR. THANH QUACH D.D.S.
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
11223G0001XGeneral Practice Dentistry12010185IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144264409
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THANH QUACH D.D.S.
Provider Business Mailing Address
First Line : 650 N GIRLS SCHOOL RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46214-3660
Country : US
Telephone Number : 317-209-9702
Fax Number : 317-209-9703
Provider Business Practice Location Address
First Line : 650 N GIRLS SCHOOL RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46214-3672
Country : US
Telephone Number : 317-209-9702
Fax Number : 317-209-9703
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2006
Last Update Date : 12/31/2021

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