Provider Demographics
NPI:1023638293
Name:PROFESSIONAL DENTAL SERVICES OF INDIANA PC
Entity type:Organization
Organization Name:PROFESSIONAL DENTAL SERVICES OF INDIANA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SWOVERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-355-1121
Mailing Address - Street 1:10601 MISSION RD STE 240
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2427
Mailing Address - Country:US
Mailing Address - Phone:913-355-1121
Mailing Address - Fax:
Practice Address - Street 1:4960 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-5937
Practice Address - Country:US
Practice Address - Phone:317-886-1578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental