Organization
A L DEHAVEN DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELA L DEHAVEN DDS (OWNER)
(765) 623-6751
Entity
Organization
Contact information
Practice address
1366 N GARDNER ST, BOX 330, SCOTTSBURG, IN 47170-7793
(812) 752-3524
(812) 752-9195
Mailing address
3225 NICHOL AVE, ANDERSON, IN 46011-3148
(765) 642-7717
(765) 649-2111
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12009405
IN
Other
Enumeration date
10/16/2014
Last updated
10/16/2014
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