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General NPI Number Information
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NPI Number | 1598923120
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Entity Type | Organization
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Legal Business Name | WOODSIDE DENTAL CENTER LLC
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 1523 STATE ST
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City | NEW ALBANY
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State | IN
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Zip | 47150-4911
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Country | US
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Telephone | 812-944-9929
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Fax |
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Provider Business Mailing Address
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Address Line | 1523 STATE ST
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City | NEW ALBANY
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State | IN
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Zip | 47150-4911
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Country | US
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Telephone | 812-944-9929
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAURICE CHRIS ZAEPFEL II
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Credential | D.M.D.
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Telephone | 812-944-9929
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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 | 12010015A
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License Number State | IN
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