Organization
K LUKE EADES DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH LUKE EADES DDS (PRESIDENT)
(812) 336-2688
Entity
Organization
Contact information
Practice address
2810 S WALNUT STREET PIKE, BLOOMINGTON, IN 47401-8403
(812) 336-2688
(812) 336-1090
Mailing address
2810 S WALNUT STREET PIKE, BLOOMINGTON, IN 47401-8403
(812) 336-2688
(812) 336-1090
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
54000865
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54000865
LICENSE NUMBER
IN
Enumeration date
02/12/2008
Last updated
02/18/2015
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