Provider Demographics
NPI:1396095832
Name:DENTAL HEALTH ASSOCIATES OF INDIANA
Entity type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES OF INDIANA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-359-3888
Mailing Address - Street 1:61 E 96TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1006
Mailing Address - Country:US
Mailing Address - Phone:317-721-1552
Mailing Address - Fax:317-663-8569
Practice Address - Street 1:61 E 96TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1006
Practice Address - Country:US
Practice Address - Phone:317-721-1552
Practice Address - Fax:317-663-8569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty