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General NPI Number Information
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NPI Number | 1194963181
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Entity Type | Organization
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Legal Business Name | WHITE RIVER DENTAL LLC
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 01/28/2009
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Provider Practice Location Address
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Address Line | 2459 W JONATHAN MOORE PIKE
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City | COLUMBUS
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State | IN
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Zip | 47201-9206
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Country | US
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Telephone | 812-378-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 5530 BRENTWICK PL
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-6393
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Country | US
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Telephone | 317-432-5214
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AARON W STRICKLAND
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Credential | DDS
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Telephone | 317-432-5214
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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 | 12010768A
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License Number State | IN
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