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Organization
DR J PEDIATRIC DENTISTRY LLC
Active
Organization
DR J PEDIATRIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN FERNANDO YEPES DDS (PEDIATRIC DENTIST)
(317) 938-1181
Entity
Organization
Contact information
Practice address
10820 PENDLETON PIKE STE B, INDIANAPOLIS, IN 46236-2952
(317) 938-1181
Mailing address
10820 PENDLETON PIKE STE B, INDIANAPOLIS, IN 46236-2952
(317) 938-1181
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
12012166A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60003191
—
IN
Enumeration date
08/11/2016
Last updated
08/11/2016
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