# WEST 10TH DENTAL GROUP, PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Oral Sugery and Implant Center of Indiana
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578757191
- **Authorized official:** DR. BRENT J. BARTA D.D.S. (PRESIDENT/OWNER)
- **Authorized official phone:** (317) 247-9512

## Contact information

- **Practice address:** 6443 W 10TH ST, SUITE 204, INDIANAPOLIS, IN 46214-6501
- **Practice address phone:** (317) 247-9512
- **Mailing address:** 6443 W 10TH ST, SUITE 204, INDIANAPOLIS, IN 46214-6501
- **Mailing address phone:** (317) 247-9512

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | IN | Yes |
| 1223P0221X | Pediatric Dentistry | 12010589A | IN | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12010678A | IN | — |

## Other

- **Enumeration date:** 08/28/2007
- **Last updated:** 08/28/2007