MEDICARE: NOBLESVILLE FAMILY DENTISTRY

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	122300000X	Dentist	12009722	IN

General Provider Information

NPI Number	:	1336345537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOBLESVILLE FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	455 SHERIDAN RD
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-1315
Country	:	US
Telephone Number	:	317-773-1302
Fax Number	:	317-773-4214

Provider Business Practice Location Address
First Line	:	455 SHERIDAN RD
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-1315
Country	:	US
Telephone Number	:	317-773-1302
Fax Number	:	317-773-4214

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RONDA S MURPHY
Credential	:
Telephone Number	:	317-773-1302

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	08/22/2020

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