Healthcare Provider Details

I. General information

NPI: 1699760280
Provider Name (Legal Business Name): ASSOCIATES IN FAMILY DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 E US 36
AVON IN
46123-7156
US

IV. Provider business mailing address

7800 E US 36
AVON IN
46123-7156
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-2700
  • Fax: 317-272-2785
Mailing address:
  • Phone: 317-272-2700
  • Fax: 317-272-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7216
License Number StateIN

VIII. Authorized Official

Name: DR. ROBERT B BOOHER
Title or Position: OWNER
Credential: DDS
Phone: 317-272-2700