Provider Demographics
NPI:1154753689
Name:AHLBRECHT, CARLY ANNE (DDS MS)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ANNE
Last Name:AHLBRECHT
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1728
Mailing Address - Country:US
Mailing Address - Phone:765-524-7093
Mailing Address - Fax:
Practice Address - Street 1:110 N STATE ROAD 267 STE B
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8475
Practice Address - Country:US
Practice Address - Phone:317-272-7206
Practice Address - Fax:317-272-8206
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011997A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics