Provider Demographics
NPI:1134691090
Name:DENTISTRY JUST FOR KIDS AND ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:DENTISTRY JUST FOR KIDS AND ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PILIPOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF DENTISTRY
Authorized Official - Phone:812-234-7322
Mailing Address - Street 1:1107 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-3817
Mailing Address - Country:US
Mailing Address - Phone:812-234-7322
Mailing Address - Fax:812-234-2065
Practice Address - Street 1:1107 OHIO ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3817
Practice Address - Country:US
Practice Address - Phone:812-234-7322
Practice Address - Fax:812-234-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty