Organization
A LYNN 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
105 HUNTER STATION WAY, SELLERSBURG, IN 47172-8915
(812) 246-1770
(812) 246-1770
Mailing address
108 SHAMROCK CIR, #1, PENDLETON, IN 46064-8563
(765) 623-6751
(765) 649-2111
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12009405
IN
Other
Enumeration date
08/25/2014
Last updated
08/25/2014
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