Organization
WILSON AND PFAU FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA BIES-PFAU (OWNER/OFFICE MANAGER)
(812) 482-1855
Entity
Organization
Contact information
Practice address
288 NORTHWOOD AVE, JASPER, IN 47546-1212
(812) 482-1855
(812) 634-6833
Mailing address
288 NORTHWOOD AVE, JASPER, IN 47546-1212
(812) 482-1855
(812) 634-6833
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659755197
NPI (ALEX M PFAU DMD)
IN
01
—
1821215781
NPI (KIM BADELL WILSON DDS)
IN
01
—
1841417706
NPI (J BRAD WILSON DDS)
IN
Enumeration date
06/30/2020
Last updated
06/30/2020
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