Healthcare Provider Details

I. General information

NPI: 1407061013
Provider Name (Legal Business Name): STRADLEY HAGERTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E. TENTH ST
GREENSBURG IN
47240-8202
US

IV. Provider business mailing address

112 E. TENTH ST
GREENSBURG IN
47240-8202
US

V. Phone/Fax

Practice location:
  • Phone: 812-663-2503
  • Fax: 812-663-6665
Mailing address:
  • Phone: 812-663-2503
  • Fax: 812-663-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7386
License Number StateIN

VIII. Authorized Official

Name: MRS. LESLEY E BEST
Title or Position: FINANCIAL COORDINATOR
Credential:
Phone: 812-663-2503