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Organization
UNIVERSITY DENTAL SERVICE PLAN INC
Active
Organization
UNIVERSITY DENTAL SERVICE PLAN INC
Active
Other names
Dental Faculty Private Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JILL ALLEN (CLINIC ADMINSTRATOR)
(317) 278-6946
Entity
Organization
Contact information
Practice address
1121 W MICHIGAN ST, ROOM 285B, INDIANAPOLIS, IN 46202-5211
(317) 278-6946
(317) 274-6583
Mailing address
1121 W MICHIGAN ST, ROOM 285B, INDIANAPOLIS, IN 46202-5211
(317) 278-6946
(317) 284-6583
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223X0008X
Oral and Maxillofacial Radiology Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Enumeration date
02/08/2007
Last updated
04/30/2010
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