# WTDG SPECIALTY GROUP LLC

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

## Provider details

- **NPI number:** 1114502283
- **Authorized official:** DR. BRENT J BARTA DDS (MEMBER)
- **Authorized official phone:** (317) 679-8506

## Contact information

- **Practice address:** 6443 W 10TH ST STE 204, INDIANAPOLIS, IN 46214-6502
- **Practice address phone:** (317) 247-9512
- **Mailing address:** 6443 W 10TH ST STE 204, INDIANAPOLIS, IN 46214-6502
- **Mailing address phone:** (317) 247-9512

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 03/10/2021
- **Last updated:** 03/10/2021