# GERMAN CHURCH RD FAMILY DENTISTRY

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

## Provider details

- **NPI number:** 1386067627
- **Authorized official:** DIANE COOMBS (OFFICE MANAGER)
- **Authorized official phone:** (317) 898-9231

## Contact information

- **Practice address:** 11020 E 10TH ST STE A, INDIANAPOLIS, IN 46229-3710
- **Practice address phone:** (317) 898-9231
- **Practice address fax:** (317) 898-9245
- **Mailing address:** 11020 E 10TH ST STE A, INDIANAPOLIS, IN 46229-3710
- **Mailing address phone:** (317) 898-9231
- **Mailing address fax:** (317) 898-9245

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12007959A | IN | Yes |
| 1223G0001X | General Practice Dentistry | 120111490A | IN | — |

## Other

- **Enumeration date:** 01/22/2014
- **Last updated:** 01/22/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100065700A | — | IN |