Provider Demographics
NPI:1053711606
Name:HOOSIER PEDIATRIC DENTAL GROUP
Entity type:Organization
Organization Name:HOOSIER PEDIATRIC DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:317-213-7454
Mailing Address - Street 1:9842 BEAVER CREEK LN
Mailing Address - Street 2:SUITE 3312
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-6532
Mailing Address - Country:US
Mailing Address - Phone:765-201-0313
Mailing Address - Fax:
Practice Address - Street 1:306 S BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3528
Practice Address - Country:US
Practice Address - Phone:765-201-0313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010878A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty