Organization
NORTHSIDE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY THURMAN (OFFICE MANAGER)
(317) 842-8453
Entity
Organization
Contact information
Practice address
15026 GREYHOUND CT, CARMEL, IN 46032-1015
(317) 842-8453
Mailing address
15026 GREYHOUND CT, CARMEL, IN 46032-1015
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
12010349A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300002251
—
IN
Enumeration date
07/03/2018
Last updated
07/03/2018
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