Organization
MIDWEST PERIODONTAL AND ORAL RECONSTRUCTION, P.C.
Active
Other names
Sonrisa-A Periodental Spa
Organization subpart
No
Provider details
NPI number
Authorized official
BRIGITTE MILLS (DIRECTOR OF BUSINESS AFFAIRS)
(317) 269-0402
Entity
Organization
Contact information
Practice address
508 INDIANA AVE, INDIANAPOLIS, IN 46202-3106
(317) 269-0402
(317) 269-0405
Mailing address
508 INDIANA AVE, INDIANAPOLIS, IN 46202-3106
(317) 269-0402
(317) 269-0405
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0300X
Periodontics
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200533430A
—
IN
Enumeration date
11/06/2006
Last updated
07/02/2008
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