=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174799845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DYER DENTAL PROFESSIONALS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2008
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2037 CHURCH ST
-----------------------------------------------------
City | DYER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46311-1729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-865-5040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2037 CHURCH ST
-----------------------------------------------------
City | DYER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46311-1729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-865-5040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST -- PRESIDENT
-----------------------------------------------------
Name | DR. SETH ANDREW TAMBRINI
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 317-418-3618
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 12010864A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------