| Wtdg Specialty Group Llc | |
|
6443 W 10th St Ste 204 Indianapolis IN 46214-6502 | |
| (317) 247-9512 | |
| Not Available |
| Full Name | Wtdg Specialty Group Llc |
|---|---|
| Speciality | Dentist |
| Location | 6443 W 10th St Ste 204, Indianapolis, Indiana |
| Authorized Official Name and Position | Brent J Barta (MEMBER) |
| Authorized Official Contact | 3176798506 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wtdg Specialty Group Llc 6443 W 10th St Ste 204 Indianapolis IN 46214-6502 Ph: (317) 247-9512 | Wtdg Specialty Group Llc 6443 W 10th St Ste 204 Indianapolis IN 46214-6502 Ph: (317) 247-9512 |
| NPI Number | 1114502283 |
|---|---|
| Provider Enumeration Date | 03/10/2021 |
| Last Update Date | 03/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114502283 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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