Provider Demographics
NPI:1902109317
Name:NORA DENTAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:NORA DENTAL ASSOCIATES, PC
Other - Org Name:NORA FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:BONNELL
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-575-2888
Mailing Address - Street 1:860 E 86TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-6859
Mailing Address - Country:US
Mailing Address - Phone:317-575-2888
Mailing Address - Fax:
Practice Address - Street 1:860 E 86TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-6859
Practice Address - Country:US
Practice Address - Phone:317-575-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009695A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty