Provider Demographics
NPI:1932718335
Name:LAFAYETTE ENDODONTICS, LLC
Entity type:Organization
Organization Name:LAFAYETTE ENDODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-513-9129
Mailing Address - Street 1:415 N 26TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2893
Mailing Address - Country:US
Mailing Address - Phone:765-448-6831
Mailing Address - Fax:
Practice Address - Street 1:415 N 26TH ST STE 302
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2893
Practice Address - Country:US
Practice Address - Phone:765-448-6831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental