# WARRICK PARK DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003153354
- **Authorized official:** DR. JED MARLIN INMAN D.D.S. (OWNER/DENTIST)
- **Authorized official phone:** (812) 897-4889

## Contact information

- **Practice address:** 800 OFFICE PARK DR, BOONVILLE, IN 47601-8601
- **Practice address phone:** (812) 897-4889
- **Practice address fax:** (812) 897-8113
- **Mailing address:** 800 OFFICE PARK DR, BOONVILLE, IN 47601-8601
- **Mailing address phone:** (812) 897-4889
- **Mailing address fax:** (812) 897-8113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12011465A | IN | — |
| 1223G0001X | General Practice Dentistry | 7613 | IN | Yes |

## Other

- **Enumeration date:** 01/07/2013
- **Last updated:** 01/07/2013