Organization
DENTAL SERVICES OF INDIANA, P.C.
Active
Parent organization
DENTAL SERVICES OF INDIANA, P.C.
Other names
ImmediaDent
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL SERVICES OF INDIANA, P.C.
Authorized official
MONICA L LONG (MANAGER OF PROVIDER CREDENTIALING)
(913) 428-1686
Entity
Organization
Contact information
Practice address
4960 S EMERSON AVE, INDIANAPOLIS, IN 46203-5937
(317) 324-4333
(866) 591-0604
Mailing address
PO BOX 11568, OVERLAND PARK, KS 66207-4268
(913) 428-1686
(866) 591-0604
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/21/2017
Last updated
05/01/2017
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