Healthcare Provider Details

I. General information

NPI: 1578045241
Provider Name (Legal Business Name): DR LINDA COLTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 W NATIONAL AVE
BRAZIL IN
47834-2437
US

IV. Provider business mailing address

803 W NATIONAL AVE
BRAZIL IN
47834-2437
US

V. Phone/Fax

Practice location:
  • Phone: 812-446-2275
  • Fax: 812-446-6038
Mailing address:
  • Phone: 812-446-2275
  • Fax: 812-446-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12009712
License Number StateIN

VIII. Authorized Official

Name: LINDA KAY COLTER
Title or Position: ORTHODONTIST
Credential: DDS,MSD
Phone: 812-446-2275