Provider Demographics
NPI:1871872317
Name:DENTAL HEALTH ASSOC OF IN PC
Entity type:Organization
Organization Name:DENTAL HEALTH ASSOC OF IN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-359-3888
Mailing Address - Street 1:1642 OLIVE BRANCH PARKE LN
Mailing Address - Street 2:SUITE 700
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6447
Mailing Address - Country:US
Mailing Address - Phone:317-215-7601
Mailing Address - Fax:
Practice Address - Street 1:1642 OLIVE BRANCH PARKE LN
Practice Address - Street 2:SUITE 700
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6447
Practice Address - Country:US
Practice Address - Phone:317-215-7601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty