Organization
BACSA DENTAL PC
Active
Other names
Emerson Avenue Detnal
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY BACSA DDS (PRESIDENT)
(317) 258-0309
Entity
Organization
Contact information
Practice address
4625 S EMERSON AVE, INDIANAPOLIS, IN 46203-5972
(317) 784-5555
Mailing address
8805 KNOTTY PINE CT, INDIANAPOLIS, IN 46227-9764
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
12010741A
IN
Other
Enumeration date
08/11/2009
Last updated
08/11/2009
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