MEDICARE: PLAINFIELD DENTAL

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	12011426A	IN

General Provider Information

NPI Number	:	1558785709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAINFIELD DENTAL

Provider Business Mailing Address
First Line	:	824 EDWARDS DR
Second Line	:	UNIT 124
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-2791
Country	:	US
Telephone Number	:	317-268-4593
Fax Number	:

Provider Business Practice Location Address
First Line	:	824 EDWARDS DR
Second Line	:	UNIT 124
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-2791
Country	:	US
Telephone Number	:	317-268-4593
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SARAH RENEE KINGSEED
Credential	:	D.D.S
Telephone Number	:	260-318-3151

Provider Enumeration Date	:	02/08/2014
Last Update Date	:	11/03/2014

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Directions to “PLAINFIELD DENTAL ” Practice Location

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