Organization
FORTVILLE FAMILY DENISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY PAUL LACONI (OWNER)
(317) 485-5251
Entity
Organization
Contact information
Practice address
14 S MAIN ST, FORTVILLE, IN 46040-1315
(317) 485-5251
Mailing address
14 S MAIN ST, FORTVILLE, IN 46040-1315
(317) 485-5251
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12008802B
IN
Other
Enumeration date
12/03/2008
Last updated
12/03/2008
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