Provider Demographics
NPI:1083820062
Name:HADLEY FAMILY DENTISTRY, INC
Entity Type:Organization
Organization Name:HADLEY FAMILY DENTISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-780-7777
Mailing Address - Street 1:5406 S EMERSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-1980
Mailing Address - Country:US
Mailing Address - Phone:317-780-7777
Mailing Address - Fax:317-780-5849
Practice Address - Street 1:5406 S EMERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-1980
Practice Address - Country:US
Practice Address - Phone:317-780-7777
Practice Address - Fax:317-780-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010497A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty