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Organization
WARRICK PARK DENTAL, LLP
Active
Organization
WARRICK PARK DENTAL, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN MELBERG DMD (CO-OWNER/DENTIST)
(812) 897-4889
Entity
Organization
Contact information
Practice address
800 OFFICE PARK DR, BOONVILLE, IN 47601-8601
(812) 897-4889
(812) 897-8113
Mailing address
800 OFFICE PARK DR, BOONVILLE, IN 47601-8601
(812) 897-4889
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023338480
DDS
IN
01
—
1447624473
DMD
IN
Enumeration date
03/29/2021
Last updated
04/05/2021
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