MEDICARE: ADVANCED DENTAL CARE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12006939	IN

General Provider Information

NPI Number	:	1124031539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DENTAL CARE PC

Provider Business Mailing Address
First Line	:	5120 CHARLESTOWN ROAD
Second Line	:	STE 6
City	:	NEW ALBANY
State	:	IN
Zip	:	47150
Country	:	US
Telephone Number	:	812-944-3411
Fax Number	:	812-944-3442

Provider Business Practice Location Address
First Line	:	5120 CHARLESTOWN ROAD
Second Line	:	STE 6
City	:	NEW ALBANY
State	:	IN
Zip	:	47150
Country	:	US
Telephone Number	:	812-944-3411
Fax Number	:	812-944-3442

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES TERRY FREY
Credential	:	DDS
Telephone Number	:	812-944-3411

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	08/22/2020

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