Organization
INDY DENTAL GROUP FORTVILLE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY LOCKE (ADMINISTRATOR)
(317) 399-5513
Entity
Organization
Contact information
Practice address
727 E BROADWAY ST, FORTVILLE, IN 46040-1565
(317) 399-5513
Mailing address
727 E BROADWAY ST, FORTVILLE, IN 46040-1565
(317) 399-5513
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
09/18/2023
Last updated
09/18/2023
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