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Southern Indiana Pediatric Dentistry, Llc
Pediatric Dentist in Bloomington, Indiana
NPI 1356634471

Southern Indiana Pediatric Dentistry, Llc is a Pediatric Dentist based in Bloomington, IN and is specialized in Pediatric Dentistry. Southern Indiana Pediatric Dentistry, Llc practices in Bloomington, IN. The NPI Number for Southern Indiana Pediatric Dentistry, Llc is 1356634471 and holds a License No. 12011284A (Indiana).

The current practice location address for Southern Indiana Pediatric Dentistry, Llc is 828 S Auto Mall Rd, Bloomington, IN and can be reached out via phone at 812-333-5437 and via fax at 812-333-6305.

Location: 828 S Auto Mall Rd, Bloomington, IN, 47401-5430
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1356634471
Provider Name
Southern Indiana Pediatric Dentistry, Llc
Credential
Provider Entity Type
Organization
Address
828 S Auto Mall Rd, Bloomington, IN, 47401-5430
Phone Number
812-333-5437
Fax Number
812-333-6305
Provider Enumeration Date
05/23/2011
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
201019080 05 IN
institution
Provider Business Practice Location Address Details
Address
828 S Auto Mall Rd
City
Bloomington
State
Indiana
Zip
47401-5430
Phone Number
812-333-5437
Fax Number
812-333-6305
person
Provider Business Mailing Address Details
Address
828 S Auto Mall Rd
City
Bloomington
State
Indiana
Zip
47401-5430
Phone Number
812-333-5437
Fax Number
812-333-6305
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
12011284A (Indiana)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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