Healthcare Provider Details

I. General information

NPI: 1811596299
Provider Name (Legal Business Name): BUEDEL ORTHODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2020
Last Update Date: 10/18/2020
Certification Date: 10/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 TUTOR LN STE 103
EVANSVILLE IN
47715-7295
US

IV. Provider business mailing address

900 TUTOR LN STE 103
EVANSVILLE IN
47715-7295
US

V. Phone/Fax

Practice location:
  • Phone: 812-589-5007
  • Fax:
Mailing address:
  • Phone: 812-589-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARAH BUEDEL
Title or Position: MANAGER
Credential: D.D.S., M.S.D.
Phone: 812-589-5007