MEDICARE: GLENDALE DENTAL ASSOCIATES II, P.C.

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	12010539A	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1528246618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENDALE DENTAL ASSOCIATES II, P.C.

Provider Business Mailing Address
First Line	:	6202 EVANSTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2100
Country	:	US
Telephone Number	:	317-251-0085
Fax Number	:	317-259-9084

Provider Business Practice Location Address
First Line	:	6202 EVANSTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2100
Country	:	US
Telephone Number	:	317-251-0085
Fax Number	:	317-259-9084

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. JOHN CHO
Credential	:	DDS
Telephone Number	:	317-251-0085

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	12/03/2018

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Directions to “GLENDALE DENTAL ASSOCIATES II, P.C. ” Practice Location

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