Organization
TLC FAMILY DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANNER CRANDELL DDS (DENTIST / OWNER)
(260) 515-3217
Entity
Organization
Contact information
Practice address
7625 S MERIDIAN ST, INDIANAPOLIS, IN 46217-4257
(317) 881-8271
Mailing address
7625 S MERIDIAN ST, INDIANAPOLIS, IN 46217-4257
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12009264A
IN DENTAL LICENSE
IN
01
—
12013136A
IN DENTAL LICENSE
IN
01
—
1689662298
NPI TYPE 1
IN
01
—
1730746710
NPI TYPE 1
IN
Enumeration date
11/10/2021
Last updated
11/10/2021
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