Individual
DR. MERNEATHA BAZILIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
6020 E 46TH ST, INDIANAPOLIS, IN 46226-3413
(317) 545-1044
(317) 545-1055
Mailing address
6020 E 46TH ST, INDIANAPOLIS, IN 46226-3413
(317) 545-1044
(317) 545-1055
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008890
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100259200A
—
IN
05
—
100259200B
—
IN
01
—
464717
UNITED CONCORDIA
IN
Enumeration date
10/04/2006
Last updated
06/11/2019
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