Organization
PARK PEDIATRIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESA ALLISON D.D.S., M.S.D. (OWNER, MANAGING MEMBER)
(317) 627-1755
Entity
Organization
Contact information
Practice address
1700 W SMITH VALLEY RD, SUITE B1, GREENWOOD, IN 46142-1599
(317) 627-1755
Mailing address
PO BOX 441143, INDIANAPOLIS, IN 46244-1143
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12011836A
IN
Other
Enumeration date
03/21/2017
Last updated
03/21/2017
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