Provider Demographics
NPI:1124031539
Name:ADVANCED DENTAL CARE PC
Entity Type:Organization
Organization Name:ADVANCED DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-944-3411
Mailing Address - Street 1:5120 CHARLESTOWN ROAD
Mailing Address - Street 2:STE 6
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150
Mailing Address - Country:US
Mailing Address - Phone:812-944-3411
Mailing Address - Fax:812-944-3442
Practice Address - Street 1:5120 CHARLESTOWN ROAD
Practice Address - Street 2:STE 6
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150
Practice Address - Country:US
Practice Address - Phone:812-944-3411
Practice Address - Fax:812-944-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120069391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty