| Immediadent | |
|
5457 W 38th St Indianapolis IN 46254-2917 | |
| (317) 291-9000 | |
| (866) 591-0604 |
| Full Name | Immediadent |
|---|---|
| Speciality | Dentist |
| Location | 5457 W 38th St, Indianapolis, Indiana |
| Authorized Official Name and Position | Monica L Long (MANAGER OF PROVIDER CREDENTIALING) |
| Authorized Official Contact | 9134281686 |
| 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) 428-1686 | Immediadent 5457 W 38th St Indianapolis IN 46254-2917 Ph: (317) 291-9000 |
| NPI Number | 1699168435 |
|---|---|
| Provider Enumeration Date | 03/17/2015 |
| Last Update Date | 04/27/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699168435 | NPI | - | NPPES |
| 200377170B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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