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General NPI Number Information
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NPI Number | 1407061013
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Entity Type | Organization
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Legal Business Name | STRADLEY HAGERTY LLC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 05/29/2009
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Provider Practice Location Address
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Address Line | 112 E. TENTH ST
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City | GREENSBURG
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State | IN
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Zip | 47240-8202
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Country | US
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Telephone | 812-663-2503
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Fax | 812-663-6665
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Provider Business Mailing Address
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Address Line | 112 E. TENTH ST
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City | GREENSBURG
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State | IN
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Zip | 47240-8202
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Country | US
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Telephone | 812-663-2503
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Fax | 812-663-6665
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Authorized Official
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Title or Position | FINANCIAL COORDINATOR
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Name | MRS. LESLEY E BEST
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Credential |
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Telephone | 812-663-2503
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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 | 7386
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License Number State | IN
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