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General NPI Number Information
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NPI Number | 1477765022
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Entity Type | Organization
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Legal Business Name | DENTAL CARE ACTION INC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1602 W THIRD STREET
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City | BLOOMINGTON
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State | IN
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Zip | 47404
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Country | US
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Telephone | 812-339-7700
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Fax | 812-339-7794
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Provider Business Mailing Address
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Address Line | 1602 W THIRD STREET
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City | BLOOMINGTON
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State | IN
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Zip | 47404
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Country | US
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Telephone | 812-339-7700
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Fax | 812-339-7794
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Authorized Official
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Title or Position | PRESIDENT BOARD OF DIRECTORS
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Name | MR. JOHN T PATRICK
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Credential |
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Telephone | 812-339-5015
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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 | 10850A
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License Number State | IN
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