MEDICARE: DENTASAFE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12007602A	IN

General Provider Information

NPI Number	:	1386881738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTASAFE LLC

Provider Business Mailing Address
First Line	:	5200 WASHINGTON AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-4863
Country	:	US
Telephone Number	:	812-488-2008
Fax Number	:	812-475-9831

Provider Business Practice Location Address
First Line	:	5200 WASHINGTON AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-4863
Country	:	US
Telephone Number	:	812-488-2008
Fax Number	:	812-475-9831

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DANIEL FINK
Credential	:	DDS
Telephone Number	:	812-488-2008

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	01/07/2009

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Directions to “DENTASAFE LLC ” Practice Location

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