Provider Demographics
NPI:1215409685
Name:RENSSELAER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:RENSSELAER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VINAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ASWATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-866-4533
Mailing Address - Street 1:210 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-2620
Mailing Address - Country:US
Mailing Address - Phone:219-866-4533
Mailing Address - Fax:
Practice Address - Street 1:210 N FRONT ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-2620
Practice Address - Country:US
Practice Address - Phone:219-866-4533
Practice Address - Fax:219-866-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental