Individual
DR. SAMUEL BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
7340 CROSSING PL, STE 200, FISHERS, IN 46038-2785
(317) 570-5480
(317) 570-5481
Mailing address
7340 CROSSING PL, STE 200, FISHERS, IN 46038-2785
(317) 570-5480
(317) 570-5481
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12010486
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200402720
—
IN
Enumeration date
10/23/2006
Last updated
05/12/2008
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