# K LUKE EADES DDS PC

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

## Provider details

- **NPI number:** 1962670034
- **Authorized official:** DR. KENNETH LUKE EADES DDS (PRESIDENT)
- **Authorized official phone:** (812) 336-2688

## Contact information

- **Practice address:** 2810 S WALNUT STREET PIKE, BLOOMINGTON, IN 47401-8403
- **Practice address phone:** (812) 336-2688
- **Practice address fax:** (812) 336-1090
- **Mailing address:** 2810 S WALNUT STREET PIKE, BLOOMINGTON, IN 47401-8403
- **Mailing address phone:** (812) 336-2688
- **Mailing address fax:** (812) 336-1090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 54000865 | IN | Yes |

## Other

- **Enumeration date:** 02/12/2008
- **Last updated:** 02/18/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 54000865 | LICENSE NUMBER | IN |