# KEYSTONE ENDODONTICS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033309471
- **Authorized official:** DR. DONALD G. ANDERSON I D.D.S.,M.S. (OWNER)
- **Authorized official phone:** (317) 569-9977

## Contact information

- **Practice address:** 3105 E 98TH ST, SUITE 130, INDIANAPOLIS, IN 46280-2005
- **Practice address phone:** (317) 569-9977
- **Mailing address:** 3105 E 98TH ST, INDIANAPOLIS, IN 46280-2005
- **Mailing address phone:** (317) 569-9977

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 12009805 | IN | Yes |

## Other

- **Enumeration date:** 08/01/2007
- **Last updated:** 08/01/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 12009805 | INDIANA DENTAL LICENSE | IN |
| 01 | — | 1649372798 | NPI TYPE I | — |