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General NPI Number Information
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NPI Number | 1558528117
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Entity Type | Organization
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Legal Business Name | MCFADDEN FAMILY DENTISTRY, P.C.
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 509 STATE ROAD 39 BYP S
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City | MARTINSVILLE
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State | IN
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Zip | 46151-1972
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Country | US
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Telephone | 765-342-3232
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Fax | 765-342-3291
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Provider Business Mailing Address
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Address Line | 509 STATE ROAD 39 BYP S
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City | MARTINSVILLE
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State | IN
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Zip | 46151-1972
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Country | US
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Telephone | 765-342-3232
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Fax | 765-342-3291
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JOHN ROBERT MCFADDEN
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Credential | D.D.S
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Telephone | 765-342-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12010102A
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License Number State | IN
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