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7318 E. U.s. 36 Suite 100 Avon IN 46123 | |
| (317) 272-7715 | |
| (317) 272-7719 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 7318 E. U.s. 36, Avon, Indiana |
| Authorized Official Name and Position | Rebecca J De La Rosa (PRESIDENT) |
| Authorized Official Contact | 3172727715 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7318 E. U.s. 36 Suite 100 Avon IN 46123 Ph: (317) 272-7715 | 7318 E. U.s. 36 Suite 100 Avon IN 46123 Ph: (317) 272-7715 |
| NPI Number | 1861557415 |
|---|---|
| Provider Enumeration Date | 12/26/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861557415 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 1200--9226 (Indiana) | Primary |
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