Provider Demographics
NPI:1366255960
Name:KALEB D. DAVIS, D.D.S., LLC
Entity type:Organization
Organization Name:KALEB D. DAVIS, D.D.S., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KALEB
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-293-5011
Mailing Address - Street 1:6002 W 62ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-2909
Mailing Address - Country:US
Mailing Address - Phone:317-293-5011
Mailing Address - Fax:
Practice Address - Street 1:6002 W 62ND ST STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2909
Practice Address - Country:US
Practice Address - Phone:317-293-5011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental