Organization
BROAD RIPPLE FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GINA ELROD (DENTIST)
(317) 257-3368
Entity
Organization
Contact information
Practice address
6117 N COLLEGE AVE, INDIANAPOLIS, IN 46220-2233
(317) 257-3368
Mailing address
6117 N. COLLEGE, INDIANAPOLIS, IN 46220
(317) 257-3368
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12007547A
IN
1223G0001X
General Practice Dentistry
12010049A
IN
1223G0001X
General Practice Dentistry
Primary
12010357A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100061910A
—
IN
Enumeration date
11/06/2009
Last updated
11/06/2009
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