Provider Demographics
NPI:1235505579
Name:FREIENDLY FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:FREIENDLY FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-877-2238
Mailing Address - Street 1:1626 S STATE ROAD 46
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-9301
Mailing Address - Country:US
Mailing Address - Phone:812-877-2238
Mailing Address - Fax:812-877-9408
Practice Address - Street 1:1626 S STATE ROAD 46
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-9301
Practice Address - Country:US
Practice Address - Phone:812-877-2238
Practice Address - Fax:812-877-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007347B261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental