# NORTHSIDE DENTAL LLC

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

## Provider details

- **NPI number:** 1558857540
- **Authorized official:** ASHLEY THURMAN (OFFICE MANAGER)
- **Authorized official phone:** (317) 842-8453

## Contact information

- **Practice address:** 15026 GREYHOUND CT, CARMEL, IN 46032-1015
- **Practice address phone:** (317) 842-8453
- **Mailing address:** 15026 GREYHOUND CT, CARMEL, IN 46032-1015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 12010349A | IN | Yes |

## Other

- **Enumeration date:** 07/03/2018
- **Last updated:** 07/03/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 300002251 | — | IN |