Healthcare Provider Details

I. General information

NPI: 1285853028
Provider Name (Legal Business Name): INDIANA FAMILY DENTISTRY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N GREEN ST
BROWNSBURG IN
46112-1026
US

IV. Provider business mailing address

505 N GREEN ST
BROWNSBURG IN
46112-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-852-5999
  • Fax: 317-852-6624
Mailing address:
  • Phone: 317-852-5999
  • Fax: 317-852-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12009870
License Number StateIN

VIII. Authorized Official

Name: DR. WILLIAM C. HINE JR.
Title or Position: SOLE OWNER
Credential: D.D.S.
Phone: 317-852-5999