MEDICARE: 360CARE DENTISTRY 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1518827096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	360CARE DENTISTRY OF INDIANA LLC

Provider Business Mailing Address
First Line	:	135 N PENNSYLVANIA ST STE 1610
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-2448
Country	:	US
Telephone Number	:	248-528-2116
Fax Number	:	502-996-8282

Provider Business Practice Location Address
First Line	:	135 N PENNSYLVANIA ST STE 1610
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-2448
Country	:	US
Telephone Number	:	248-528-2116
Fax Number	:	502-996-8282

Authorized Official
Title or Position	:	VICE PRESIDENT OF REVENUE ASSURANCE
Name	:	JOY L STEVENS
Credential	:
Telephone Number	:	502-244-2441

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	11/17/2025

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