# ANGELA DEHAVEN DDS LLC

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

## Provider details

- **NPI number:** 1972901163
- **Authorized official:** DR. ANGELA LYNN DEHAVEN DDS (OWNER)
- **Authorized official phone:** (765) 642-7717

## Contact information

- **Practice address:** 3225 NICHOL AVE, ANDERSON, IN 46011-3148
- **Practice address phone:** (765) 642-7717
- **Practice address fax:** (765) 649-2111
- **Mailing address:** 3225 NICHOL AVE, ANDERSON, IN 46011-3148
- **Mailing address phone:** (765) 642-7717
- **Mailing address fax:** (765) 649-2111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12009405 | IN | Yes |

## Other

- **Enumeration date:** 12/20/2014
- **Last updated:** 12/23/2014