Organization
SOUTH INDY DENTAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS QUILL D.D.S. (PRESIDENT)
(317) 881-5000
Entity
Organization
Contact information
Practice address
1090 NORTHCHASE PKWY SE, STE. 150, MARIETTA, GA 30067-6405
(770) 916-5031
Mailing address
5217 COMMERCE CIR, INDIANAPOLIS, IN 46237-9747
(317) 881-5000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
06/13/2016
Last updated
06/13/2016
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