# NORTH VERNON FAMILY DENTAL LLC

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

## Provider details

- **NPI number:** 1669820643
- **Authorized official:** DIPESH SITARAM DDS (OWNER)
- **Authorized official phone:** (812) 342-9666

## Contact information

- **Practice address:** 623 N STATE ST, NORTH VERNON, IN 47265-1043
- **Practice address phone:** (812) 346-6884
- **Practice address fax:** (812) 346-1717
- **Mailing address:** 623 N STATE ST, NORTH VERNON, IN 47265-1043
- **Mailing address phone:** (812) 346-6884
- **Mailing address fax:** (812) 346-1717

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12012474A | IN | Yes |

## Other

- **Enumeration date:** 05/31/2016
- **Last updated:** 05/31/2016