Provider Demographics
NPI:1013534684
Name:WILSON AND PFAU FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:WILSON AND PFAU FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIES-PFAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-482-1855
Mailing Address - Street 1:288 NORTHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1212
Mailing Address - Country:US
Mailing Address - Phone:812-482-1855
Mailing Address - Fax:812-634-6833
Practice Address - Street 1:288 NORTHWOOD AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1212
Practice Address - Country:US
Practice Address - Phone:812-482-1855
Practice Address - Fax:812-634-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1821215781OtherNPI (KIM BADELL WILSON DDS)
IN1659755197OtherNPI (ALEX M PFAU DMD)
IN1841417706OtherNPI (J BRAD WILSON DDS)