# FAIRMOUNT FAMILY DENTIST

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

## Provider details

- **NPI number:** 1518412139
- **Authorized official:** DR. DAVID J SHOCK DDS (OWNER)
- **Authorized official phone:** (765) 948-4107

## Contact information

- **Practice address:** 215 E WASHINGTON ST, FAIRMOUNT, IN 46928-1747
- **Practice address phone:** (765) 948-4107
- **Mailing address:** 215 E WASHINGTON ST, FAIRMOUNT, IN 46928-1747
- **Mailing address phone:** (765) 948-4107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 12011164A | IN | Yes |

## Other

- **Enumeration date:** 08/24/2016
- **Last updated:** 08/24/2016