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General NPI Number Information
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NPI Number | 1104770346
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Entity Type | Organization
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Legal Business Name | DENTURA LLC
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Dates
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Enumeration Date | 02/24/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 412 W WALNUT ST
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City | KOKOMO
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State | IN
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Zip | 46901-8407
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Country | US
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Telephone | 317-979-3768
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Fax |
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Provider Business Mailing Address
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Address Line | 13845 NANSEMOND DR
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City | CARMEL
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State | IN
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Zip | 46032-1217
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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 | MEMBER
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Name | DR. ALEC DOUGLAS WILLARD
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Credential | DDS
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Telephone | 317-979-3768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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