Provider Demographics
NPI:1124121793
Name:CARMEL DENTAL CARE, PC
Entity type:Organization
Organization Name:CARMEL DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-848-1771
Mailing Address - Street 1:1980 E 116TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3599
Mailing Address - Country:US
Mailing Address - Phone:317-848-1771
Mailing Address - Fax:317-848-1371
Practice Address - Street 1:1980 E 116TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3599
Practice Address - Country:US
Practice Address - Phone:317-848-1771
Practice Address - Fax:317-848-1371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120090281223G0001X
IN54001033A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty