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General NPI Number Information
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NPI Number | 1861833147
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Entity Type | Organization
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Legal Business Name | HUNTINBURG FAMILY DENTISTRY
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 517 E 5TH ST
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City | HUNTINGBURG
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State | IN
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Zip | 47542-1004
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Country | US
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Telephone | 812-683-4100
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Fax | 812-683-4110
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Provider Business Mailing Address
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Address Line | 517 E 5TH ST
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City | HUNTINGBURG
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State | IN
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Zip | 47542-1004
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Country | US
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Telephone | 812-683-4100
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Fax | 812-683-4110
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SHANNON ELISA WOOD
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Credential | D.D.S.
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Telephone | 812-683-4100
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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 | 12009892A
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License Number State | IN
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