Provider Demographics
NPI:1871923433
Name:EAGLE CREEK DENTISTRY, LLC
Entity type:Organization
Organization Name:EAGLE CREEK DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PREETINDERJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-295-1000
Mailing Address - Street 1:5685 LAFAYETTE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-6170
Mailing Address - Country:US
Mailing Address - Phone:317-295-1000
Mailing Address - Fax:317-295-1005
Practice Address - Street 1:5685 LAFAYETTE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-6170
Practice Address - Country:US
Practice Address - Phone:317-295-1000
Practice Address - Fax:317-295-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009533122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200277940AMedicaid