Provider Demographics
NPI:1124503966
Name:PARADISE DENTAL LLC
Entity type:Organization
Organization Name:PARADISE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HUONG
Authorized Official - Middle Name:T
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-643-7117
Mailing Address - Street 1:4745 STATESMEN DR STE E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-5649
Mailing Address - Country:US
Mailing Address - Phone:317-643-7117
Mailing Address - Fax:317-643-7112
Practice Address - Street 1:4745 STATESMEN DR STE E
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-5649
Practice Address - Country:US
Practice Address - Phone:317-643-7117
Practice Address - Fax:317-643-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental