Provider Demographics
NPI:1063670883
Name:VAN, MINDY M (DDS, MSD)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:M
Last Name:VAN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9002 N MERIDIAN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5381
Mailing Address - Country:US
Mailing Address - Phone:317-846-4980
Mailing Address - Fax:317-846-4982
Practice Address - Street 1:9002 N MERIDIAN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5381
Practice Address - Country:US
Practice Address - Phone:317-846-4980
Practice Address - Fax:317-846-4982
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010771A1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics