# KDG INDIANA TWO LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KENTUCKIANA DENTAL GROUP
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1285145433
- **Legal business name:** KENTUCKIANA DENTAL GROUP
- **Authorized official:** ADRIENNE NICHOLSON (FINANCIAL COORDINATOR)
- **Authorized official phone:** (812) 523-1860

## Contact information

- **Practice address:** 321 W BRUCE ST STE A, SEYMOUR, IN 47274-2319
- **Practice address phone:** (812) 523-1860
- **Mailing address:** PO BOX 305, SEYMOUR, IN 47274-0305

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 10/16/2017
- **Last updated:** 10/16/2017