Healthcare Provider Details

I. General information

NPI: 1710273099
Provider Name (Legal Business Name): NEW PARIS FAMILY DENTISTRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67470 FERNBROOK RD
NEW PARIS IN
46553-9761
US

IV. Provider business mailing address

67470 FERNBROOK RD
NEW PARIS IN
46553-9761
US

V. Phone/Fax

Practice location:
  • Phone: 574-831-4477
  • Fax: 574-831-4488
Mailing address:
  • Phone: 574-831-4477
  • Fax: 574-831-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12009975
License Number StateIN

VIII. Authorized Official

Name: DR. LAURA A MARKLEY
Title or Position: OWNER
Credential: DDS
Phone: 574-831-4477