DR J PEDIATRIC DENTISTRY LLC NPI 1629522289

NPI Information

NPI: 1629522289
Provider Name: DR J PEDIATRIC DENTISTRY LLC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
10820 PENDLETON PIKE STE B
INDIANAPOLIS, IN
ZIP 46236
Phone: (317) 938-1181
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DR J PEDIATRIC DENTISTRY LLC is a dental clinic center in Indianapolis, IN. DR J PEDIATRIC DENTISTRY LLC NPI is 1629522289. The provider is registered as an organization entity type.

The provider's business location address is:

10820 PENDLETON PIKE STE B
INDIANAPOLIS, IN
ZIP 46236-952
Phone: (317) 938-1181

The provider's authorized official is Juan Fernando Yepes .
The authorized official title is Pediatric Dentist and has the following contact phone number (317) 938-1181.

The enumeration date for this NPI number is 8/11/2016 and was last updated on 8/11/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental	12012166A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	60003191	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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