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General NPI Number Information
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NPI Number | 1598825770
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Entity Type | Organization
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Legal Business Name | DENTAL HEALTH ASSOCIATES OF INDIANA
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 12802 TOWNEPARK WAY SUITE 100
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City | LOUISVILLE
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State | KY
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Zip | 40243-2308
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Country | US
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Telephone | 502-423-9111
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Fax | 502-423-9330
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Provider Business Mailing Address
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Address Line | 12802 TOWNEPARK WAY SUITE 100
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City | LOUISVILLE
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State | KY
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Zip | 40243-2308
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Country | US
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Telephone | 502-423-9111
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Fax | 502-423-9330
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Authorized Official
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Title or Position | CEO
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Name | TIM HOAGLAND
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Credential |
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Telephone | 502-423-9111
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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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