# INDIANA UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Indiana University School of Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689790552
- **Authorized official:** TINA D FOSTER (ASSISTANT DIRECTOR OF REVENUE CYCLE)
- **Authorized official phone:** (317) 278-3632

## Contact information

- **Practice address:** 1121 W MICHIGAN ST, INDIANAPOLIS, IN 46202-5211
- **Practice address phone:** (317) 274-7433
- **Mailing address:** 1121 W MICHIGAN ST, INDIANAPOLIS, IN 46202-5211
- **Mailing address phone:** (317) 278-3632
- **Mailing address fax:** (317) 274-2603

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0300X | Periodontics | — | — | — |
| 1223P0700X | Prosthodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |
| 1223X2210X | Orofacial Pain Dentistry | — | — | — |

## Other

- **Enumeration date:** 03/22/2007
- **Last updated:** 02/24/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100277260 | — | IN |