Organization
UNIVERSITY PEDIATRIC DENTISTRY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN J SANDERS D.D.S., M.S. (PRESIDENT)
(317) 944-9604
Entity
Organization
Contact information
Practice address
705 RILEY HOSPITAL DR, ROC - SUITE 4205, INDIANAPOLIS, IN 46202-5109
(317) 944-9604
(317) 948-0760
Mailing address
705 RILEY HOSPITAL DR, ROC - SUITE 4205, INDIANAPOLIS, IN 46202-5109
(317) 944-9604
(317) 948-0760
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100061940
—
IN
05
—
100087220
—
IN
05
—
100176300
—
IN
01
—
1003587
GROUP ID PRIV. INSUR
IN
05
—
100440160
—
IN
01
—
103337
CHILDREN SPECIAL HEALTH
IN
05
—
200331160
—
IN
05
—
200515490
—
IN
Enumeration date
03/08/2007
Last updated
02/19/2013
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