Organization
INDY DENTAL IMPLANTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLIE M SCHAUB DDS, MSD (OWNER)
(317) 884-8633
Entity
Organization
Contact information
Practice address
8445 S EMERSON AVE, SUITE 101, INDIANAPOLIS, IN 46237-9596
(317) 884-8633
(317) 300-1896
Mailing address
8445 S EMERSON AVE, SUITE 101, INDIANAPOLIS, IN 46237-9596
(317) 884-8633
(317) 300-1896
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
12010873A
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12009521A
IN
Other
Enumeration date
09/30/2015
Last updated
09/30/2015
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