# JACK E NICEWANDER

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

## Provider details

- **NPI number:** 1689067928
- **Authorized official:** DR. JACK E NICEWANDER DDS (OWNER)
- **Authorized official phone:** (317) 842-1903

## Contact information

- **Practice address:** 5511 E 82ND ST, STE F, INDIANAPOLIS, IN 46250-4698
- **Practice address phone:** (317) 842-1903
- **Practice address fax:** (317) 849-8054
- **Mailing address:** 5511 E 82ND ST, STE F, INDIANAPOLIS, IN 46250-4698
- **Mailing address phone:** (317) 842-1903
- **Mailing address fax:** (317) 849-8054

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 12007501A | IN | Yes |

## Other

- **Enumeration date:** 03/11/2015
- **Last updated:** 04/06/2015