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General NPI Number Information
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NPI Number | 1013676675
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Entity Type | Organization
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Legal Business Name | ACCESS DENTAL OF TERRE HAUTE LLC
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 3359 S US HIGHWAY 41
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City | TERRE HAUTE
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State | IN
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Zip | 47802
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Country | US
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Telephone | 812-645-4110
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Fax |
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Provider Business Mailing Address
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Address Line | 3359 S US HIGHWAY 41
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City | TERRE HAUTE
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State | IN
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Zip | 47802
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGIONAL DIRECTOR
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Name | ANDREA CARRILLO
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Credential |
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Telephone | 512-351-2612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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