Provider Demographics
NPI:1144264409
Name:QUACH, THANH (DDS)
Entity type:Individual
Prefix:DR
First Name:THANH
Middle Name:
Last Name:QUACH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N GIRLS SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3660
Mailing Address - Country:US
Mailing Address - Phone:317-209-9702
Mailing Address - Fax:317-209-9703
Practice Address - Street 1:650 N GIRLS SCHOOL RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3672
Practice Address - Country:US
Practice Address - Phone:317-209-9702
Practice Address - Fax:317-209-9703
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120101851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200239770BMedicaid