| Immediadent | |
|
2128 Mounds Rd Anderson IN 46016-5713 | |
| (765) 642-0400 | |
| (866) 519-0604 |
| Full Name | Immediadent |
|---|---|
| Speciality | Dentist |
| Location | 2128 Mounds Rd, Anderson, Indiana |
| Authorized Official Name and Position | Monica L Long (MANAGER OF PROVIDER CREDENTIALING) |
| Authorized Official Contact | 9134281686 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Immediadent Po Box 11568 Overland Park KS 66207-4268 Ph: (913) 428-1686 | Immediadent 2128 Mounds Rd Anderson IN 46016-5713 Ph: (765) 642-0400 |
| NPI Number | 1851784607 |
|---|---|
| Provider Enumeration Date | 03/17/2015 |
| Last Update Date | 04/27/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851784607 | NPI | - | NPPES |
| 200377170D | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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