Organization
DECATUR FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY A TAYLOR DDS (OWNER)
(317) 418-3848
Entity
Organization
Contact information
Practice address
5021 KENTUCKY AVE STE G, INDIANAPOLIS, IN 46221-3650
(317) 455-1425
(317) 455-1428
Mailing address
5021 KENTUCKY AVE STE G, INDIANAPOLIS, IN 46221-3650
(317) 455-1425
(317) 455-1428
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12012151A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201230770
—
IN
Enumeration date
06/19/2018
Last updated
06/19/2018
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