MEDICARE: FAMILY DENTAL OF PENDLETON

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	12009722	IN

General Provider Information

NPI Number	:	1710474531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DENTAL OF PENDLETON

Provider Business Mailing Address
First Line	:	210 E WATER ST
Second Line	:
City	:	PENDLETON
State	:	IN
Zip	:	46064-1047
Country	:	US
Telephone Number	:	765-778-7558
Fax Number	:	765-778-9000

Provider Business Practice Location Address
First Line	:	210 E WATER ST
Second Line	:
City	:	PENDLETON
State	:	IN
Zip	:	46064-1047
Country	:	US
Telephone Number	:	765-778-7558
Fax Number	:	765-778-9000

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. RONDA S MURPHY
Credential	:
Telephone Number	:	657-778-7558

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	04/17/2018

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Directions to “FAMILY DENTAL OF PENDLETON ” Practice Location

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