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General NPI Number Information
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NPI Number | 1669866992
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Entity Type | Organization
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Legal Business Name | DARRELL DEEM DDS, INC
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 100 W VAN TREES ST
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City | WASHINGTON
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State | IN
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Zip | 47501-1564
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Country | US
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Telephone | 812-254-7550
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Fax | 812-254-5750
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Provider Business Mailing Address
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Address Line | 100 W VAN TREES ST
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City | WASHINGTON
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State | IN
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Zip | 47501-1564
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Country | US
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Telephone | 812-254-7550
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Fax | 812-254-5750
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Authorized Official
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Title or Position | OFFICE ADMINISTRATION
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Name | L. RENE BEAN
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Credential |
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Telephone | 812-254-5011
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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 | 12008380
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License Number State | IN
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