Provider Demographics
NPI:1437962370
Name:ORTHODONTIC EXPERTS OF INDIANA, LLC
Entity type:Organization
Organization Name:ORTHODONTIC EXPERTS OF INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BZDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-941-9224
Mailing Address - Street 1:1001 N STATE ROAD 135 STE A1
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1349
Mailing Address - Country:US
Mailing Address - Phone:317-667-0348
Mailing Address - Fax:
Practice Address - Street 1:1001 N STATE ROAD 135 STE A1
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1349
Practice Address - Country:US
Practice Address - Phone:317-667-0348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHODONTIC EXPERTS OF INDIANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty