Healthcare Provider Details

I. General information

NPI: 1316016256
Provider Name (Legal Business Name): TED LOUIS HUPPERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 STRINGTOWN RD
EVANSVILLE IN
47711-3361
US

IV. Provider business mailing address

2424 STRINGTOWN RD
EVANSVILLE IN
47711-3361
US

V. Phone/Fax

Practice location:
  • Phone: 812-424-2400
  • Fax: 812-424-8377
Mailing address:
  • Phone: 812-424-2400
  • Fax: 812-424-8377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12007611A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: