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Organization
DANVILLE DENTAL CLINIC, PC
Active
Organization
DANVILLE DENTAL CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL CLARK BEATY (PRESIDENT)
(317) 745-7711
Entity
Organization
Contact information
Practice address
2166 E MAIN ST, DANVILLE, IN 46122-9082
(317) 745-7711
(317) 745-1744
Mailing address
2166 E MAIN ST, DANVILLE, IN 46122-9082
(317) 745-7711
(317) 745-1744
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12006829A
IN
1223G0001X
General Practice Dentistry
Primary
12009222A
IN
1223G0001X
General Practice Dentistry
12010827A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000607321
UNITED CONCORDIA
IN
05
—
100133940A
—
IN
Enumeration date
02/22/2007
Last updated
09/02/2009
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