Immediadent Of Indiana, P.C.
Dentist in New Albany, IN. Organization (NPI-2).
NPI number1154508331
StatusActive
Last updated in NPPESApr 28, 2017
Details
- NPI
- 1154508331
- Entity type
- Organization (NPI-2)
- Legal business name
- Immediadent Of Indiana, P.C.
- Organization subpart
- Yes
- Enumeration date
- Jan 30, 2008
- Last updated
- Apr 28, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 12010746A | IN | Yes |
Other names
- Immediadent (Doing Business As)
Practice location
360 New Albany PlzNew Albany, IN 47150-4654
Phone 812-945-4040 · Fax 866-591-0604
Mailing address
Po Box 11568Overland Park, KS 66207-4268
Phone 913-428-1686 · Fax 866-591-0604
Authorized official
Monica L Long
Manager Of Provider Credentialing
9134281686
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