Provider Demographics
NPI:1891916169
Name:INDIANA RESTORATIVE DENTISTRY PC
Entity type:Organization
Organization Name:INDIANA RESTORATIVE DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:317-844-4155
Mailing Address - Street 1:370 MEDICAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2916
Mailing Address - Country:US
Mailing Address - Phone:317-844-4155
Mailing Address - Fax:
Practice Address - Street 1:370 MEDICAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2916
Practice Address - Country:US
Practice Address - Phone:317-844-4155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70331223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty