Provider Demographics
NPI:1306527825
Name:INDIANA OROFACIAL PAIN, LLC
Entity type:Organization
Organization Name:INDIANA OROFACIAL PAIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MASSIMILIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:DI GIOSIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-386-9780
Mailing Address - Street 1:880 MONON GREEN BLVD APT 403
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3487
Mailing Address - Country:US
Mailing Address - Phone:919-386-9780
Mailing Address - Fax:
Practice Address - Street 1:880 MONON GREEN BLVD APT 403
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3487
Practice Address - Country:US
Practice Address - Phone:919-386-9780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Single Specialty