Provider Demographics
NPI:1366742371
Name:EAST INDY DENTAL CARE, LLC
Entity type:Organization
Organization Name:EAST INDY DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:LECLERE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-494-9435
Mailing Address - Street 1:5607 E. WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219
Mailing Address - Country:US
Mailing Address - Phone:317-375-2273
Mailing Address - Fax:317-375-2272
Practice Address - Street 1:5607 E. WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219
Practice Address - Country:US
Practice Address - Phone:317-375-2273
Practice Address - Fax:317-375-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011298A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty