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General NPI Number Information
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NPI Number | 1487866711
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Entity Type | Organization
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Legal Business Name | WABASH VALLEY DENTAL GROUP
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 1518 S 3RD ST
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City | TERRE HAUTE
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State | IN
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Zip | 47802-1012
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Country | US
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Telephone | 812-232-2557
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Fax | 812-234-1365
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Provider Business Mailing Address
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Address Line | 1518 S 3RD ST
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City | TERRE HAUTE
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State | IN
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Zip | 47802-1012
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Country | US
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Telephone | 812-232-2557
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Fax | 812-234-1365
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Authorized Official
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Title or Position | RECEPTIONIST
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Name | MRS. SUZANNE LINDLEY
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Credential |
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Telephone | 812-232-2557
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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 |
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License Number State |
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