Organization
UNIVERSITY DENTAL SERVICE PLAN INC
Active
Other names
Dental Faculty Private Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JILL ALLEN (CLINIC ADMINSTRATOR)
(317) 278-6946
Entity
Organization
Contact information
Practice address
1121 W MICHIGAN ST, ROOM 285B, INDIANAPOLIS, IN 46202-5211
(317) 278-6946
(317) 274-6583
Mailing address
1121 W MICHIGAN ST, ROOM 285B, INDIANAPOLIS, IN 46202-5211
(317) 278-6946
(317) 284-6583
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223X0008X
Oral and Maxillofacial Radiology Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Enumeration date
02/08/2007
Last updated
04/30/2010
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