Provider Demographics
NPI:1073638052
Name:DENTAL ASSOCIATES OF EVANSVILLE P.C
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF EVANSVILLE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAGMAR
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-853-3334
Mailing Address - Street 1:7855 W STATE ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2542
Mailing Address - Country:US
Mailing Address - Phone:812-853-3334
Mailing Address - Fax:812-853-7971
Practice Address - Street 1:7855 W STATE ROUTE 66
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2542
Practice Address - Country:US
Practice Address - Phone:812-853-3334
Practice Address - Fax:812-853-7971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN54001014A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty