# PRITCHARD JASTREMSKI DENTAL ASSOC. LLC

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

## Provider details

- **NPI number:** 1639291958
- **Authorized official:** DR. KELLY ANDREW JASTREMSKI DDS (OWNER MANAGER)
- **Authorized official phone:** (812) 339-2811

## Contact information

- **Practice address:** 1550 S LIBERTY DR, BLOOMINGTON, IN 47403-5167
- **Practice address phone:** (812) 339-2811
- **Practice address fax:** (812) 961-0746
- **Mailing address:** 1550 S LIBERTY DR, BLOOMINGTON, IN 47403-5167
- **Mailing address phone:** (812) 339-2811
- **Mailing address fax:** (812) 961-0746

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12009671 | IN | Yes |

## Other

- **Enumeration date:** 04/06/2007
- **Last updated:** 08/22/2020