# IDC DENTAL GROUP, INC.

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

## Provider details

- **NPI number:** 1093164535
- **Authorized official:** DR. KELLIE MICHELLE SCHAUB DDS, MSD (OWNER/PRESIDENT)
- **Authorized official phone:** (317) 884-8633

## Contact information

- **Practice address:** 5150 E STOP 11 RD, SUITE 11, INDIANAPOLIS, IN 46237-8628
- **Practice address phone:** (317) 889-6000
- **Practice address fax:** (317) 889-1618
- **Mailing address:** 8445 S EMERSON AVE, SUITE 101, INDIANAPOLIS, IN 46237-9596
- **Mailing address phone:** (317) 884-8633
- **Mailing address fax:** (317) 300-1896

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12007400A | IN | — |
| 1223G0001X | General Practice Dentistry | 12012473A | IN | Yes |

## Other

- **Enumeration date:** 06/06/2016
- **Last updated:** 06/06/2016