# 96TH STREET FAMILY DENTISTRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Holt Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124735782
- **Authorized official:** MEGAN MUNCHEL (REGIONAL MANAGER)
- **Authorized official phone:** (765) 529-7616

## Contact information

- **Practice address:** 7862 E 96TH ST, FISHERS, IN 46037-9629
- **Practice address phone:** (317) 576-9393
- **Mailing address:** 340 PARKVIEW DR, NEW CASTLE, IN 47362-2945

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/03/2022
- **Last updated:** 11/03/2022