Organization
BRAZIL DENTAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER RICHEY DDS (OWNER)
(812) 448-3639
Entity
Organization
Contact information
Practice address
21 N WASHINGTON ST, BRAZIL, IN 47834-2204
(812) 448-3639
Mailing address
21 N WASHINGTON ST, BRAZIL, IN 47834-2204
(812) 448-3639
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201229120B
—
IN
05
—
201234800A
—
IN
05
—
300004053
—
IN
Enumeration date
09/18/2018
Last updated
09/18/2018
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