Organization
INDIANA DENTAL CLINIC PC
Active
Other names
Atlanta Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FENNIS BLEDSOE (CHIEF EXECUTIVE OFFICER)
(765) 292-2366
Entity
Organization
Contact information
Practice address
29101 ST RD 19, ATLANTA, IN 46031
(765) 292-2366
(765) 292-2081
Mailing address
PO BOX 186, ATLANTA, IN 46031
(765) 292-2366
(765) 292-2081
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/07/2006
Last updated
08/22/2020
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