Provider Demographics
NPI:1700949724
Name:SANDERSWEDDELLPEDIATRIC DENTALSPECIALIST
Entity type:Organization
Organization Name:SANDERSWEDDELLPEDIATRIC DENTALSPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-575-2899
Mailing Address - Street 1:860 EAST 86TH STREET
Mailing Address - Street 2:SUITE1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-6859
Mailing Address - Country:US
Mailing Address - Phone:317-575-2899
Mailing Address - Fax:317-575-2898
Practice Address - Street 1:860 EAST 86TH STREET
Practice Address - Street 2:SUITE1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-6859
Practice Address - Country:US
Practice Address - Phone:317-575-2899
Practice Address - Fax:317-575-2898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty