Organization
SOUTHERN INDIANA PEDIATRIC DENTISTRY, LLC
Active
Other names
Rasche Pediatric Dentistry, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW L RASCHE D.D.S., M.S.D. (OWNER/MEMBER)
(812) 661-0612
Entity
Organization
Contact information
Practice address
828 S AUTO MALL RD, BLOOMINGTON, IN 47401-5430
(812) 333-5437
(812) 333-6305
Mailing address
828 S AUTO MALL RD, BLOOMINGTON, IN 47401-5430
(812) 333-5437
(812) 333-6305
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12011284A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201019080
—
IN
Enumeration date
05/23/2011
Last updated
11/22/2011
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