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General NPI Number Information
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NPI Number | 1295006328
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Entity Type | Organization
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Legal Business Name | BATESVILLE DENTAL
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 981 STATE RD., 46 E STE B
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City | BATESVILLE
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State | IN
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Zip | 47006-8608
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Country | US
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Telephone | 812-934-3651
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Fax | 812-932-0203
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Provider Business Mailing Address
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Address Line | 981 STATE RD., 46 E STE B
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City | BATESVILLE
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State | IN
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Zip | 47006-8608
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Country | US
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Telephone | 812-934-3651
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Fax | 812-932-0203
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Authorized Official
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Title or Position | OWNER
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Name | BRADLEY P BROUGHTON
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Credential | DDS
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Telephone | 812-934-3651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12011136A
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License Number State | IN
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