Healthcare Provider Details

I. General information

NPI: 1679797153
Provider Name (Legal Business Name): FRANKLIN FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 W JEFFERSON ST
FRANKLIN IN
46131-2123
US

IV. Provider business mailing address

1035 W JEFFERSON ST
FRANKLIN IN
46131-2123
US

V. Phone/Fax

Practice location:
  • Phone: 317-736-6361
  • Fax:
Mailing address:
  • Phone: 317-736-6361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010199
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12009943
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12008791
License Number StateIN

VIII. Authorized Official

Name: SHARON HALEY
Title or Position: DENTIST
Credential: DDS
Phone: 317-736-6361