# A LYNN DEHAVEN DDS LLC

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

## Provider details

- **NPI number:** 1255731543
- **Authorized official:** DR. ANGELA L DEHAVEN DDS (OWNER)
- **Authorized official phone:** (765) 623-6751

## Contact information

- **Practice address:** 105 HUNTER STATION WAY, SELLERSBURG, IN 47172-8915
- **Practice address phone:** (812) 246-1770
- **Practice address fax:** (812) 246-1770
- **Mailing address:** 108 SHAMROCK CIR, \#1, PENDLETON, IN 46064-8563
- **Mailing address phone:** (765) 623-6751
- **Mailing address fax:** (765) 649-2111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12009405 | IN | Yes |

## Other

- **Enumeration date:** 08/25/2014
- **Last updated:** 08/25/2014