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Organization
KEYSTONE ENDODONTICS
Active
Organization
KEYSTONE ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD G. ANDERSON I D.D.S.,M.S. (OWNER)
(317) 569-9977
Entity
Organization
Contact information
Practice address
3105 E 98TH ST, SUITE 130, INDIANAPOLIS, IN 46280-2005
(317) 569-9977
Mailing address
3105 E 98TH ST, INDIANAPOLIS, IN 46280-2005
(317) 569-9977
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
12009805
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12009805
INDIANA DENTAL LICENSE
IN
01
—
1649372798
NPI TYPE I
—
Enumeration date
08/01/2007
Last updated
08/01/2007
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