MEDICARE: COMMUNITY DENTAL CENTER

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

General Provider Information

NPI Number	:	1154189900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY DENTAL CENTER

Provider Business Mailing Address
First Line	:	2620 E 62ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2934
Country	:	US
Telephone Number	:	317-251-2371
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 E 62ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2934
Country	:	US
Telephone Number	:	317-251-2371
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW ALEXANDER
Credential	:
Telephone Number	:	317-251-2371

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	03/07/2024

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Directions to “COMMUNITY DENTAL CENTER ” Practice Location

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