| Idc Dental Group, Inc. | |
|
5150 E Stop 11 Rd Suite 11 Indianapolis IN 46237-8628 | |
| (317) 889-6000 | |
| (317) 889-1618 |
| Full Name | Idc Dental Group, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5150 E Stop 11 Rd, Indianapolis, Indiana |
| Authorized Official Name and Position | Kellie Michelle Schaub (OWNER/PRESIDENT) |
| Authorized Official Contact | 3178848633 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idc Dental Group, Inc. 8445 S Emerson Ave Suite 101 Indianapolis IN 46237-9596 Ph: (317) 884-8633 | Idc Dental Group, Inc. 5150 E Stop 11 Rd Suite 11 Indianapolis IN 46237-8628 Ph: (317) 889-6000 |
| NPI Number | 1093164535 |
|---|---|
| Provider Enumeration Date | 06/06/2016 |
| Last Update Date | 06/06/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093164535 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 12007400A (Indiana) | Secondary |
| 1223G0001X | Dentist - General Practice | 12012473A (Indiana) | Primary |
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