# INDY DENTAL IMPLANTS LLC

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

## Provider details

- **NPI number:** 1982074118
- **Authorized official:** DR. KELLIE M SCHAUB DDS, MSD (OWNER)
- **Authorized official phone:** (317) 884-8633

## Contact information

- **Practice address:** 8445 S EMERSON AVE, SUITE 101, INDIANAPOLIS, IN 46237-9596
- **Practice address phone:** (317) 884-8633
- **Practice address fax:** (317) 300-1896
- **Mailing address:** 8445 S EMERSON AVE, SUITE 101, INDIANAPOLIS, IN 46237-9596
- **Mailing address phone:** (317) 884-8633
- **Mailing address fax:** (317) 300-1896

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0700X | Prosthodontics | 12010873A | IN | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12009521A | IN | — |

## Other

- **Enumeration date:** 09/30/2015
- **Last updated:** 09/30/2015