Healthcare Provider Details

I. General information

NPI: 1629603915
Provider Name (Legal Business Name): TDS IN SIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3684 US- 150 #9
FLOYDS KNOBS IN
47119
US

IV. Provider business mailing address

3684 US-150 #9
FLOYDS KNOBS IN
47119
US

V. Phone/Fax

Practice location:
  • Phone: 812-569-2955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ADRIENNE NICHOLSON
Title or Position: REGIONAL MANAGER
Credential: CDA
Phone: 812-569-2955