MEDICARE: SOUTH INDY DENTAL, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223P0221X	Pediatric Dentistry
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
3	122300000X	Dentist
4	1223E0200X	Endodontics
5	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1679922470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH INDY DENTAL, P.C.

Provider Business Mailing Address
First Line	:	5217 COMMERCE CIR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-9747
Country	:	US
Telephone Number	:	317-881-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1090 NORTHCHASE PKWY SE
Second Line	:	STE. 150
City	:	MARIETTA
State	:	GA
Zip	:	30067-6405
Country	:	US
Telephone Number	:	770-916-5031
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS QUILL
Credential	:	D.D.S.
Telephone Number	:	317-881-5000

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	06/13/2016

Similar Medicare Providers

1083713747 — SHARNN AARIN SHEPHEARD DDS
Practice Location Address:

1090 NORTHCHASE PKWY SE , SUITE 290
MARIETTA, GA
30067-6405

Practice Phone: 678-904-5665
Practice Fax:

1255501466 — BENEVIS, LLC
Practice Location Address:

1090 NORTHCHASE PKWY SE , SUITE 150
MARIETTA, GA
30067-6405

Practice Phone: 770-916-5028
Practice Fax:

1447565239 — NIPING WANG BDS, PHD
Practice Location Address:

1090 NORTHCHASE PKWY SE , SUITE 290
MARIETTA, GA
30067-6405

Practice Phone: 678-904-5665
Practice Fax: 678-247-7862

1073891925 — TARA C. PURSELY DMD
Practice Location Address:

1090 NORTHCHASE PKWY SE , SUITE 290
MARIETTA, GA
30067-6405

Practice Phone: 770-916-9526
Practice Fax:

1821430497 — YULIYA SALMERON
Practice Location Address:

1090 NORTHCHASE PKWY SE , SUITE 290
MARIETTA, GA
30067-6405

Practice Phone: 770-916-5037
Practice Fax:

1750750360 — MANHATTAN BOULEVARD DENTAL ASSOCIATES, A PROFESSIONAL CORPORATION
Practice Location Address:

1090 NORTHCHASE PKWY SE , STE 150
MARIETTA, GA
30067-6405

Practice Phone: 770-916-5031
Practice Fax:

Directions to “SOUTH INDY DENTAL, P.C. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.