Organization
WILEY PEDIATRIC DENTISTRY, LLC
Active
Other names
Speedway Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DILLON T WILEY DDS, MSD (DENTIST / OWNER)
(317) 695-3604
Entity
Organization
Contact information
Practice address
6211 W 30TH ST STE D, INDIANAPOLIS, IN 46224-3057
(317) 299-0353
Mailing address
6211 W 30TH ST STE D, INDIANAPOLIS, IN 46224-3057
(317) 299-0353
(317) 298-8196
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12009076A
IN DENTAL LICENSE
IN
01
—
12012708A
IN DENTAL LICENSE
IN
01
—
1629161518
NPI TYPE 1
IN
01
—
1790213098
NPI TYPE 1
IN
05
—
300003242
—
IN
05
—
300015869
—
IN
Enumeration date
09/20/2019
Last updated
07/21/2020
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