Provider Demographics
NPI:1609290402
Name:DENVER DENTAL CARE INC.
Entity type:Organization
Organization Name:DENVER DENTAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MUSSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-985-3434
Mailing Address - Street 1:57 N CHANDLER ST
Mailing Address - Street 2:PO BOX 125
Mailing Address - City:DENVER
Mailing Address - State:IN
Mailing Address - Zip Code:46926-2304
Mailing Address - Country:US
Mailing Address - Phone:765-985-3434
Mailing Address - Fax:
Practice Address - Street 1:57 N CHANDLER ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:IN
Practice Address - Zip Code:46926-2304
Practice Address - Country:US
Practice Address - Phone:765-985-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006627A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100179210AMedicaid