NPIMap

Organization Active NPI

Indy Dental Health, LLC

  • Dentist
  • Indianapolis, IN
National Provider Identifier
1710334131
Registry record updated May 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12011779A Issued in IN
Legal business name
INDY DENTAL HEALTH, LLC
Practice address
9002 N Meridian St Ste 210
Indianapolis, IN 46260-5350
Phone
(317) 872-3465
Fax
(317) 872-4340
NPI assigned
May 16, 2016
Last updated
May 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matthew Fraiz, DMDNPI 1134351091
Title
Dentist
Phone
(317) 872-3465

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 12011331C IN
Dentist 122300000X 12011779A IN Primary

Addresses

Primary practice location

9002 N Meridian St Ste 210
Indianapolis, IN 46260-5350

Mailing address

9002 N Meridian St Ste 210
Indianapolis, IN 46260-5350
Phone (317) 872-3465

Other identifiers 2

IdentifierTypeStateIssuer
1134351091MedicaidIN
1740578491MedicaidIN

National Provider Directory

National Provider Directory

Locations

9002 N Meridian St
Ste 210
Indianapolis, IN 46260
Phone (317) 575-8122

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463356800000",
    "number": "1710334131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9002 N MERIDIAN ST STE 210",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462605350",
            "telephone_number": "317-872-3465",
            "fax_number": "317-872-4340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9002 N MERIDIAN ST STE 210",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462605350",
            "telephone_number": "317-872-3465",
            "fax_number": "317-872-4340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDY DENTAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-16",
        "last_updated": "2016-05-16",
        "status": "A",
        "authorized_official_last_name": "FRAIZ",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "317-872-3465",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011331C",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011779A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134351091",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740578491",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.