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General NPI Number Information
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NPI Number | 1174693220
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Entity Type | Organization
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Legal Business Name | DENTAL HEALTH ASSOCIATES OF INDIANA
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1121 W 2ND ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2160
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Country | US
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Telephone | 812-339-1671
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Fax | 812-337-1231
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Provider Business Mailing Address
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Address Line | 9505 WILLIAMSBURG PLZ STE 301
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City | LOUISVILLE
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State | KY
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Zip | 40222-5090
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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 | EXECUTIVE
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Name | MR. TIM HOAGLAND
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Credential |
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Telephone | 502-423-9111
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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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