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General NPI Number Information
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NPI Number | 1881178382
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Entity Type | Organization
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Legal Business Name | SHEETS FAMILY DENTISTRY, INC.
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 98 S 100 E, SUITE B
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City | FOWLER
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State | IN
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Zip | 47944
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Country | US
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Telephone | 765-884-0018
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Fax | 765-884-0019
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Provider Business Mailing Address
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Address Line | PO BOX 456
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City | FOWLER
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State | IN
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Zip | 47944-0456
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Country | US
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Telephone | 765-884-0018
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Fax | 765-884-0019
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. REBECCA SUE SHEETS
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Credential |
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Telephone | 765-884-0018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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