1497954622 NPI number — HEARTLAND DENTAL CARE OF INDIANA, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497954622 NPI number — HEARTLAND DENTAL CARE OF INDIANA, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTLAND DENTAL CARE OF INDIANA, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1497954622
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 W LINCOLN RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
KOKOMO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46902-3850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-453-7692
Provider Business Mailing Address Fax Number:
765-453-7694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 W LINCOLN RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KOKOMO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46902-3850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-453-7692
Provider Business Practice Location Address Fax Number:
765-453-7694
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KROEGER
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
INS COOR
Authorized Official Telephone Number:
217-540-5100

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com