# HOOSIER DENTURES & DENTAL SURGERY, LLC

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

## Provider details

- **NPI number:** 1609002724
- **Authorized official:** DR. SCOTT THOLE DDS (OWNER)
- **Authorized official phone:** (317) 809-7790

## Contact information

- **Practice address:** 1200 S PERU ST, CICERO, IN 46034-9161
- **Practice address phone:** (317) 809-7790
- **Mailing address:** 1200 S PERU ST, CICERO, IN 46034-9161
- **Mailing address phone:** (317) 809-7790

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 12010014 | IN | Yes |

## Other

- **Enumeration date:** 06/03/2009
- **Last updated:** 06/03/2009