Provider Demographics
NPI:1326403221
Name:CARMEL PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:CARMEL PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-846-3496
Mailing Address - Street 1:12174 N MERIDIAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4578
Mailing Address - Country:US
Mailing Address - Phone:317-846-3496
Mailing Address - Fax:317-846-4497
Practice Address - Street 1:12174 N MERIDIAN ST STE 200
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4578
Practice Address - Country:US
Practice Address - Phone:317-846-3496
Practice Address - Fax:317-846-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1497075501Medicaid
IN1578122354Medicaid
IN1780942060Medicaid