Provider Demographics
NPI:1578350641
Name:INDIANA EMERGENCY DENTAL FISHERS LLC
Entity type:Organization
Organization Name:INDIANA EMERGENCY DENTAL FISHERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:463-276-0541
Mailing Address - Street 1:7015 US 31 STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-8619
Mailing Address - Country:US
Mailing Address - Phone:463-276-0541
Mailing Address - Fax:463-276-0541
Practice Address - Street 1:9860 WESTPOINT DR STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3398
Practice Address - Country:US
Practice Address - Phone:463-276-0541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty