# OLIVE BRANCH DENTAL-1 LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Olive Branch Dental Lafayette Rd
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356002778
- **Authorized official:** DR. SRINIVAS DURSHANAPALLI DDS (PRESIDENT)
- **Authorized official phone:** (217) 303-5955

## Contact information

- **Practice address:** 5470 LAFAYETTE RD, INDIANAPOLIS, IN 46254-1620
- **Practice address phone:** (317) 643-7777
- **Practice address fax:** (317) 933-8454
- **Mailing address:** 5470 LAFAYETTE RD, INDIANAPOLIS, IN 46254-1620
- **Mailing address phone:** (317) 643-7777
- **Mailing address fax:** (317) 933-8454

## Taxonomy

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

## Other

- **Enumeration date:** 01/07/2022
- **Last updated:** 01/07/2022