Provider Demographics
NPI:1861775587
Name:DECATUR FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:DECATUR FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:SCEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-865-1193
Mailing Address - Street 1:5021 KENTUCKY AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-3625
Mailing Address - Country:US
Mailing Address - Phone:317-455-1425
Mailing Address - Fax:317-455-1428
Practice Address - Street 1:5021 KENTUCKY AVE
Practice Address - Street 2:SUITE G
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-3625
Practice Address - Country:US
Practice Address - Phone:317-455-1425
Practice Address - Fax:317-455-1428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty