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General NPI Number Information
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NPI Number | 1588114235
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Entity Type | Organization
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Legal Business Name | DENVER FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 57 N CHANDLER ST
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City | DENVER
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State | IN
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Zip | 46926-2304
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Country | US
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Telephone | 765-985-3434
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Fax | 765-985-2449
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Provider Business Mailing Address
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Address Line | PO BOX 125
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City | DENVER
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State | IN
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Zip | 46926-0125
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Country | US
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Telephone | 765-985-3434
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Fax | 765-985-2449
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL LASZYNSKI
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Credential | DDS
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Telephone | 765-985-3434
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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 |
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License Number State |
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