Bacon, Samuel
Bacon, Samuel is an sole proprietor health care provider with primary practice located at 7340 Crossing Pl Ste 200, Fishers IN 46038-2785. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Bacon, Samuel can be contacted via phone (317) 570-5480.Contact Information
Primary practice address
7340 Crossing Pl Ste 200
Fishers IN 46038-2785
Phone: (317) 570-5480
Fax: (317) 570-5481
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 12010486 | Indiana |
Profile Details
| NPI number | 1811070857 |
|---|---|
| LBN Legal business name | Bacon, Samuel |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 23rd, 2006 |
| Last updated | May 12th, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1811070857 | NPPES |
| Indiana | MEDICAID | 200402720 |
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