MEDICARE: PREFERRED DENTAL CARE, PC

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	12009522	IN

General Provider Information

NPI Number	:	1699895995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED DENTAL CARE, PC

Provider Business Mailing Address
First Line	:	8280 NORTH MICHIGAN RD
Second Line	:	SUITE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268
Country	:	US
Telephone Number	:	317-337-0233
Fax Number	:	317-337-0234

Provider Business Practice Location Address
First Line	:	8280 NORTH MICHIGAN RD
Second Line	:	SUITE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268
Country	:	US
Telephone Number	:	317-337-0233
Fax Number	:	317-337-0234

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIQUITA MARQUINEZ PALANCA-BEVERIDGE
Credential	:	DDS
Telephone Number	:	317-337-0233

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	08/22/2020

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