# DENTAL PROFESSIONALS OF INDIANA, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DENTAL PROFESSIONALS OF INDIANA, P.C.
- **Other names:** Grand Maple Dental Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1487497467
- **Legal business name:** DENTAL PROFESSIONALS OF INDIANA, P.C.
- **Authorized official:** CEMYIRA MCDOUGAL (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 764-8609

## Contact information

- **Practice address:** 249 W TOURNAMENT TRL, WESTFIELD, IN 46074-6223
- **Practice address phone:** (463) 622-2060
- **Practice address fax:** (463) 622-2059
- **Mailing address:** 249 W TOURNAMENT TRL, WESTFIELD, IN 46074-6223
- **Mailing address phone:** (463) 622-2060
- **Mailing address fax:** (463) 622-2059

## Taxonomy

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

## Other

- **Enumeration date:** 06/17/2024
- **Last updated:** 06/17/2024