| Indiana Dental Clinic Pc | |
|
29101 St Rd 19 Atlanta IN 46031 | |
| (765) 292-2366 | |
| (765) 292-2081 |
| Full Name | Indiana Dental Clinic Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 29101 St Rd 19, Atlanta, Indiana |
| Authorized Official Name and Position | Fennis Bledsoe (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7652922366 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana Dental Clinic Pc Po Box 186 Atlanta IN 46031 Ph: (765) 292-2366 | Indiana Dental Clinic Pc 29101 St Rd 19 Atlanta IN 46031 Ph: (765) 292-2366 |
| NPI Number | 1790888170 |
|---|---|
| Provider Enumeration Date | 09/07/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790888170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |