Individual
DR. SANDRA E BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1980 E 116TH STREET, STE 150, CARMEL, IN 46032
(317) 848-1771
(317) 848-1371
Mailing address
1980 E 116TH STREET, STE 150, CARMEL, IN 46032
(317) 848-1771
(317) 848-1371
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009028
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12009028B
IN BOARD OF PHARMACY CSR
IN
Enumeration date
08/24/2006
Last updated
03/07/2023
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