# MALEK FANSA D.D.S., LLC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gentle Family Dentistry at Fort Ben Harrison
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619412103
- **Authorized official:** DR. MALEK FANSA D.D.S. (DENTIST/OWNER)
- **Authorized official phone:** (317) 545-6545

## Contact information

- **Practice address:** 9620 E 59TH ST, INDIANAPOLIS, IN 46216-1020
- **Practice address phone:** (317) 545-6545
- **Mailing address:** 13119 MAYWICK DR, FISHERS, IN 46037-4425

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12010260A | IN | Yes |

## Other

- **Enumeration date:** 12/20/2016
- **Last updated:** 12/20/2016