Provider Demographics
NPI:1447730692
Name:ALDRICH PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:ALDRICH PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:463-701-5437
Mailing Address - Street 1:10373 E COUNTY ROAD 100 N
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-1250
Mailing Address - Country:US
Mailing Address - Phone:463-701-5437
Mailing Address - Fax:463-209-0482
Practice Address - Street 1:10373 E COUNTY ROAD 100 N
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-1250
Practice Address - Country:US
Practice Address - Phone:463-701-5437
Practice Address - Fax:463-209-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011675A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201097750AMedicaid