Healthcare Provider Details

I. General information

NPI: 1477952968
Provider Name (Legal Business Name): DENZINGER FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5104 CHARLESTOWN RD
NEW ALBANY IN
47150-9429
US

IV. Provider business mailing address

5104 CHARLESTOWN RD
NEW ALBANY IN
47150-9429
US

V. Phone/Fax

Practice location:
  • Phone: 270-314-7469
  • Fax:
Mailing address:
  • Phone: 270-314-7469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12009852
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12009852
License Number StateIN

VIII. Authorized Official

Name: DR. SARA LYNN DENZINGER-ROWE
Title or Position: DENTIST
Credential: D.D.S.
Phone: 812-941-1400