# IMMEDIADENT PC

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

## Provider details

- **NPI number:** 1578517132
- **Authorized official:** MRS. DENISE BEVER (NATIONAL MANAGER)
- **Authorized official phone:** (317) 577-5758

## Contact information

- **Practice address:** 8845 BOEHNING LANE, INDIANAPOLIS, IN 46219
- **Practice address phone:** (317) 899-1112
- **Practice address fax:** (317) 899-1117
- **Mailing address:** 6150 E 82ND ST, INDIANAPOLIS, IN 46250
- **Mailing address phone:** (317) 577-5758
- **Mailing address fax:** (317) 577-5753

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12010195 | IN | Yes |

## Other

- **Enumeration date:** 05/19/2006
- **Last updated:** 08/22/2020