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NPI Code Detail

MEDICARE: DR. ERIC LAMONT TREADWELL D.D.S.

MEDICARE: DR. ERIC LAMONT TREADWELL D.D.S.
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
11223G0001XGeneral Practice Dentistry12009983IN

Other Identifiers

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

General Provider Information

NPI Number : 1669404331
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC LAMONT TREADWELL D.D.S.
Provider Business Mailing Address
First Line : 5510 S EAST ST STE A
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-1939
Country : US
Telephone Number : 317-786-1733
Fax Number : 317-786-8367
Provider Business Practice Location Address
First Line : 5510 S EAST ST STE A
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-1939
Country : US
Telephone Number : 317-786-1733
Fax Number : 317-786-8367
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 04/25/2012

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