Immediadent of Indiana, P.C.
NPI 1578732806ActiveOrganization· Dentist· Clarksville, IN
Dentist in Clarksville, Indiana, registered in NPPES in February 2008, part of Immediadent of Indiana, P.C. The authorized official on file is Monica L. Long, Manager Of Provider Credentialing.
Overview
| NPI | 1578732806 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Immediadent of Indiana, P.C. |
| NPI issued | Feb 20, 2008 |
| Last updated in NPPES | Apr 28, 2017 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | 12010746A | IN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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