Healthcare Provider Details

I. General information

NPI: 1205005543
Provider Name (Legal Business Name): BROWNSBURG DENTAL PROFESSIONALS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 PATRICK PL SUITE B
BROWNSBURG IN
46112-2431
US

IV. Provider business mailing address

1040 PATRICK PL SUITE B
BROWNSBURG IN
46112-2431
US

V. Phone/Fax

Practice location:
  • Phone: 317-852-9787
  • Fax:
Mailing address:
  • Phone: 317-852-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12008750
License Number StateIN

VIII. Authorized Official

Name: DR. JOHN A LOEFFLER
Title or Position: PRESIDENT
Credential:
Phone: 317-852-9787