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General NPI Number Information
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NPI Number | 1386894756
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Entity Type | Organization
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Legal Business Name | BLUFF CREEK FAMILY DENTAL
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 9351 STATE ROAD 144
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City | MARTINSVILLE
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State | IN
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Zip | 46151-5848
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Country | US
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Telephone | 317-422-4944
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Fax |
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Provider Business Mailing Address
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Address Line | 9351 STATE ROAD 144
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City | MARTINSVILLE
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State | IN
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Zip | 46151-5848
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Country | US
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Telephone | 317-422-4944
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. KIRK ANDREW YEGERLEHNER
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Credential | D.D.S.
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Telephone | 317-422-4944
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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 | 12010995A
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License Number State | IN
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