| Northeast Dental Care Llc | |
|
6132 Allisonville Rd Indianapolis IN 46220-4608 | |
| (317) 259-7310 | |
| (317) 259-7321 |
| Full Name | Northeast Dental Care Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6132 Allisonville Rd, Indianapolis, Indiana |
| Authorized Official Name and Position | Jerome Cureton (PRINCIPAL MEMBER) |
| Authorized Official Contact | 3179895534 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Dental Care Llc 6132 Allisonville Rd Indianapolis IN 46220-4608 Ph: (317) 259-7310 | Northeast Dental Care Llc 6132 Allisonville Rd Indianapolis IN 46220-4608 Ph: (317) 259-7310 |
| NPI Number | 1942676242 |
|---|---|
| Provider Enumeration Date | 08/20/2015 |
| Last Update Date | 08/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942676242 | NPI | - | NPPES |
| 1558448043 | Other | IN | INDIVIDUAL NPI NUMBER |
| 200014250B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 12009713 (Indiana) | Primary |
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