# GREAT LAKES FAMILY DENTAL GROUP-INDIANAPOLIS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Great Lakes Family Dental Group-Indianapolis
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982078853
- **Authorized official:** MRS. PATRICIA J HART (CORPORATE MANAGER)
- **Authorized official phone:** (317) 841-1111

## Contact information

- **Practice address:** 7465 E 82ND ST, INDIANAPOLIS, IN 46256-1459
- **Practice address phone:** (317) 841-1111
- **Mailing address:** 7465 E 82ND ST, INDIANAPOLIS, IN 46256-1459
- **Mailing address phone:** (317) 841-1111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 11/16/2015
- **Last updated:** 11/16/2015