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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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