Healthcare Provider Details

I. General information

NPI: 1891029310
Provider Name (Legal Business Name): RELIANT FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4827 DAVIS LANT DR STE #G
EVANSVILLE IN
47715-8946
US

IV. Provider business mailing address

4827 DAVIS LANT DR STE #G
EVANSVILLE IN
47715-8946
US

V. Phone/Fax

Practice location:
  • Phone: 812-402-7676
  • Fax: 812-402-7979
Mailing address:
  • Phone: 812-402-7676
  • Fax: 812-402-7979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number12010454A
License Number StateIN

VIII. Authorized Official

Name: DR. CHRISTOPHER JOSEPH MEUNIER
Title or Position: DENTIST
Credential: DDS
Phone: 812-402-7676