Organization
IDC DENTAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLIE MICHELLE SCHAUB DDS, MSD (OWNER/PRESIDENT)
(317) 884-8633
Entity
Organization
Contact information
Practice address
5150 E STOP 11 RD, SUITE 11, INDIANAPOLIS, IN 46237-8628
(317) 889-6000
(317) 889-1618
Mailing address
8445 S EMERSON AVE, SUITE 101, INDIANAPOLIS, IN 46237-9596
(317) 884-8633
(317) 300-1896
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12007400A
IN
1223G0001X
General Practice Dentistry
Primary
12012473A
IN
Other
Enumeration date
06/06/2016
Last updated
06/06/2016
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