# MIDWEST DENTAL SPECIALISTS, LLC

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

## Provider details

- **NPI number:** 1922869015
- **Authorized official:** GLORIA ROYER AS (OFFICE / HR MANAGER)
- **Authorized official phone:** (765) 447-9319

## Contact information

- **Practice address:** 1650 W OAK ST STE 206, ZIONSVILLE, IN 46077-3836
- **Practice address phone:** (317) 349-0419
- **Practice address fax:** (317) 342-4149
- **Mailing address:** 415 N 26TH ST STE 303, LAFAYETTE, IN 47904-2893
- **Mailing address phone:** (765) 447-9319
- **Mailing address fax:** (765) 447-7227

## Taxonomy

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

## Other

- **Enumeration date:** 01/17/2024
- **Last updated:** 01/17/2024