# TEVERBAUGH4 LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Teverbaugh Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932441847
- **Authorized official:** DR. DIANA TEVERBAUGH (DENTIST)
- **Authorized official phone:** (317) 572-8626

## Contact information

- **Practice address:** 10967 ALLISONVILLE RD, SUITE 200, FISHERS, IN 46038-2632
- **Practice address phone:** (317) 572-8626
- **Mailing address:** 10967 ALLISONVILLE RD, SUITE 200, FISHERS, IN 46038-2632
- **Mailing address phone:** (317) 572-8626
- **Mailing address fax:** (317) 284-1276

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12011392A | IN | Yes |

## Other

- **Enumeration date:** 03/19/2013
- **Last updated:** 06/24/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2009779108 | — | IN |