# 86TH STREET COMPLETE DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** 86TH STREET Complete Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194247940
- **Authorized official:** MONA P SINGH (OWNER)
- **Authorized official phone:** (317) 748-4603

## Contact information

- **Practice address:** 3810 W 86TH ST, INDIANAPOLIS, IN 46268
- **Practice address phone:** (317) 707-6453
- **Mailing address:** 3810 W 86TH ST, INDIANAPOLIS, IN 46268-1905
- **Mailing address phone:** (317) 707-6453

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 07/13/2017
- **Last updated:** 02/26/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 300015766 | — | IN |