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General NPI Number Information
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NPI Number | 1871362855
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Entity Type | Organization
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Legal Business Name | DECATUR FAMILY DENTISTRY OF ADAMS COUNTY LLC
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Dates
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Enumeration Date | 01/01/2024
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Last Update Date | 01/01/2024
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Provider Practice Location Address
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Address Line | 1020 SOUTHAMPTON DR
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City | DECATUR
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State | IN
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Zip | 46733-1049
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Country | US
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Telephone | 260-724-8410
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Fax | 260-724-0474
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Provider Business Mailing Address
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Address Line | 1020 SOUTHAMPTON DR
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City | DECATUR
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State | IN
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Zip | 46733-1049
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Country | US
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Telephone | 260-724-8410
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Fax | 260-724-0474
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | RONALD LYNN HAMMOND
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Credential | DDS
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Telephone | 260-724-8410
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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 |
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License Number State |
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