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General NPI Number Information
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NPI Number | 1295464782
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Entity Type | Organization
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Legal Business Name | BADELL DENTAL CLINIC LLC
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 1800 S US HIGHWAY 35
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City | KNOX
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State | IN
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Zip | 46534-8681
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Country | US
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Telephone | 574-248-0456
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Fax | 574-772-5643
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Provider Business Mailing Address
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Address Line | 1800 S US HIGHWAY 35
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City | KNOX
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State | IN
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Zip | 46534-8681
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Country | US
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Telephone | 574-248-0456
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Fax | 574-772-5643
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NIKKI COOK
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Credential |
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Telephone | 574-772-3666
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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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