# UNIVERSITY DENTAL SERVICE PLAN INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dental Faculty Private Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407996291
- **Authorized official:** MS. JILL ALLEN (CLINIC ADMINSTRATOR)
- **Authorized official phone:** (317) 278-6946

## Contact information

- **Practice address:** 1121 W MICHIGAN ST, ROOM 285B, INDIANAPOLIS, IN 46202-5211
- **Practice address phone:** (317) 278-6946
- **Practice address fax:** (317) 274-6583
- **Mailing address:** 1121 W MICHIGAN ST, ROOM 285B, INDIANAPOLIS, IN 46202-5211
- **Mailing address phone:** (317) 278-6946
- **Mailing address fax:** (317) 284-6583

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | — |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 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