Organization
WEST 10TH DENTAL GROUP, PROFESSIONAL CORPORATION
Active
Other names
Oral Sugery and Implant Center of Indiana
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT J. BARTA D.D.S. (PRESIDENT/OWNER)
(317) 247-9512
Entity
Organization
Contact information
Practice address
6443 W 10TH ST, SUITE 204, INDIANAPOLIS, IN 46214-6501
(317) 247-9512
Mailing address
6443 W 10TH ST, SUITE 204, INDIANAPOLIS, IN 46214-6501
(317) 247-9512
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IN
1223P0221X
Pediatric Dentistry
12010589A
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12010678A
IN
Other
Enumeration date
08/28/2007
Last updated
08/28/2007
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