# IMMEDIADENT OF INDIANA, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** IMMEDIADENT OF INDIANA, P.C.
- **Other names:** ImmediaDent
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1477946374
- **Legal business name:** IMMEDIADENT OF INDIANA, P.C.
- **Authorized official:** MONICA L LONG (MANAGER OF PROVIDER CREDENTIALING)
- **Authorized official phone:** (913) 428-1686

## Contact information

- **Practice address:** 8845 BOEHNING LN, INDIANAPOLIS, IN 46219-1974
- **Practice address phone:** (317) 899-1112
- **Practice address fax:** (866) 591-0604
- **Mailing address:** PO BOX 11568, OVERLAND PARK, KS 66207-4268
- **Mailing address phone:** (913) 428-1686
- **Mailing address fax:** (866) 591-0604

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 03/17/2015
- **Last updated:** 04/27/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200377170A | — | IN |