| Indiana Periodontics | |
|
45 N Madison Ave Greenwood IN 46142-3526 | |
| (317) 887-3180 | |
| (317) 882-2718 |
| Full Name | Indiana Periodontics |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 45 N Madison Ave, Greenwood, Indiana |
| Authorized Official Name and Position | Kristin M Jackson (OWNER) |
| Authorized Official Contact | 3178873180 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana Periodontics 45 N Madison Ave Greenwood IN 46142-3526 Ph: (317) 887-3180 | Indiana Periodontics 45 N Madison Ave Greenwood IN 46142-3526 Ph: (317) 887-3180 |
| NPI Number | 1427143643 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 06/16/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427143643 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 12009767 (Indiana) | Primary |
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