MEDICARE: ORTHODONTIC EXPERTS OF INDIANA, LLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1437962370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHODONTIC EXPERTS OF INDIANA, LLC

Provider Business Mailing Address
First Line	:	1001 N STATE ROAD 135 STE A1
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1349
Country	:	US
Telephone Number	:	317-667-0348
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 N STATE ROAD 135 STE A1
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1349
Country	:	US
Telephone Number	:	317-667-0348
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	MONIKA BZDAL
Credential	:
Telephone Number	:	773-941-9224

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	01/27/2025

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