1336678804 NPI number — DR. KARA BROTHERS D.M.D, MSD

Table of content: DR. ALIREZA NILI D.D.S. (NPI 1225477169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336678804 NPI number — DR. KARA BROTHERS D.M.D, MSD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROTHERS
Provider First Name:
KARA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D, MSD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336678804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 N DELAWARE STREET
Provider Second Line Business Mailing Address:
APT 705
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-750-8209
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRAL INDIANA ENDODONTICS 360 S EMERSON AVE
Provider Second Line Business Practice Location Address:
STE 600
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-882-8300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  018002022 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223E0200X , with the licence number: 12013123A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)