| Immediadent | |
|
3269 W. 86th Street Suite A-2 Indianapolis IN 46268-3822 | |
| (317) 542-3440 | |
| (913) 800-6967 |
| Full Name | Immediadent |
|---|---|
| Speciality | Dentist |
| Location | 3269 W. 86th Street, Indianapolis, Indiana |
| Authorized Official Name and Position | Amy Wheeler (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 9138006952 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Immediadent Po Box 11568 Overland Park KS 66207-4268 Ph: (913) 428-1674 | Immediadent 3269 W. 86th Street Suite A-2 Indianapolis IN 46268-3822 Ph: (317) 542-3440 |
| NPI Number | 1063560555 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 04/12/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063560555 | NPI | - | NPPES |
| 200377170 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (Indiana) | Primary |
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