Healthcare Provider Details

I. General information

NPI: 1821583675
Provider Name (Legal Business Name): BBB OF IN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 E TIPTON ST
SEYMOUR IN
47274-3561
US

IV. Provider business mailing address

PO BOX 437169
LOUISVILLE KY
40253-7169
US

V. Phone/Fax

Practice location:
  • Phone: 812-524-8282
  • Fax: 812-522-7289
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PARDUE
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 502-548-2402