=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679399406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARMONY DENTISTRY OF FORTVILLE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2024
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 S MAPLE ST
-----------------------------------------------------
City | FORTVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46040-1675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-349-8156
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3825 HEARTHSTONE DR
-----------------------------------------------------
City | ZIONSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46077-5515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-336-9368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST, OWNER
-----------------------------------------------------
Name | DR. JESSICA BARTON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 260-349-8156
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------