| Goodwine Dental, Llc | |
|
210 E 91st St Ste A Indianapolis IN 46240-1570 | |
| (317) 818-7777 | |
| (317) 818-7779 |
| Full Name | Goodwine Dental, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 210 E 91st St Ste A, Indianapolis, Indiana |
| Authorized Official Name and Position | Ronda Richelle Cox (OFFICE MANAGER) |
| Authorized Official Contact | 3178187777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Goodwine Dental, Llc 210 E 91st St Ste A Indianapolis IN 46240-1570 Ph: (317) 818-7777 | Goodwine Dental, Llc 210 E 91st St Ste A Indianapolis IN 46240-1570 Ph: (317) 818-7777 |
| NPI Number | 1376218909 |
|---|---|
| Provider Enumeration Date | 08/16/2021 |
| Last Update Date | 08/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376218909 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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