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General NPI Number Information
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NPI Number | 1811022924
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Entity Type | Organization
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Legal Business Name | DANVILLE DENTAL CLINIC, PC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 2166 E MAIN ST
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City | DANVILLE
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State | IN
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Zip | 46122-9082
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Country | US
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Telephone | 317-745-7711
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Fax | 317-745-1744
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Provider Business Mailing Address
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Address Line | 2166 E MAIN ST
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City | DANVILLE
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State | IN
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Zip | 46122-9082
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Country | US
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Telephone | 317-745-7711
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Fax | 317-745-1744
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL CLARK BEATY
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Credential |
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Telephone | 317-745-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12010827A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12006829A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12009222A
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License Number State | IN
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