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Organization

JACK E NICEWANDER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JACK E NICEWANDER DDS (OWNER)
(317) 842-1903
Entity
Organization

Contact information

Practice address
5511 E 82ND ST, STE F, INDIANAPOLIS, IN 46250-4698
(317) 842-1903
(317) 849-8054
Mailing address
5511 E 82ND ST, STE F, INDIANAPOLIS, IN 46250-4698
(317) 842-1903
(317) 849-8054

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
12007501A
IN

Other

Enumeration date
03/11/2015
Last updated
04/06/2015
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