Provider Demographics
NPI:1023721172
Name:STARKE COUNTY FAMILY DENTISTRY
Entity type:Organization
Organization Name:STARKE COUNTY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RABION
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:FRASURE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-806-6832
Mailing Address - Street 1:308 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH JUDSON
Mailing Address - State:IN
Mailing Address - Zip Code:46366-1155
Mailing Address - Country:US
Mailing Address - Phone:574-806-6832
Mailing Address - Fax:
Practice Address - Street 1:1800 S US HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-8681
Practice Address - Country:US
Practice Address - Phone:574-772-3666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental