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General NPI Number Information
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NPI Number | 1649070699
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Entity Type | Organization
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Legal Business Name | PITTSBORO FAMILY DENTISTRY CAMPBELL LLC
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 204 N MAPLE ST
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City | PITTSBORO
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State | IN
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Zip | 46167-9164
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Country | US
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Telephone | 706-346-7944
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Fax |
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Provider Business Mailing Address
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Address Line | 954 BERKHAMSTED LN
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City | CARMEL
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State | IN
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Zip | 46032-3683
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Country | US
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Telephone | 706-346-7944
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Fax |
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Authorized Official
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Title or Position | REGIONAL OPERATIONS SUPERVISOR
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Name | TENNILLE SPENCE
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Credential |
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Telephone | 317-370-1158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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