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NPI Code Detail

MEDICARE: DR. GLEN AJITH KARUNANAYAKE BDS MSC

MEDICARE: DR. GLEN AJITH KARUNANAYAKE BDS MSC
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
11223E0200XEndodontics12014333AIN
21223E0200XEndodontics68587ZZ

General Provider Information

NPI Number : 1912482704
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GLEN AJITH KARUNANAYAKE BDS MSC
Provider Business Mailing Address
First Line : 1121 W MICHIGAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5211
Country : US
Telephone Number : 317-274-7433
Fax Number :
Provider Business Practice Location Address
First Line : 1121 W MICHIGAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5211
Country : US
Telephone Number : 317-274-7433
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2018
Last Update Date : 06/17/2026

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