Provider Demographics
NPI:1235776022
Name:KNIGHTSTOWN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:KNIGHTSTOWN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MEYER
Authorized Official - Last Name:PLOEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-561-2035
Mailing Address - Street 1:2891 E 450 S
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-9727
Mailing Address - Country:US
Mailing Address - Phone:765-561-2035
Mailing Address - Fax:
Practice Address - Street 1:8788 S STATE ROAD 109
Practice Address - Street 2:
Practice Address - City:KNIGHTSTOWN
Practice Address - State:IN
Practice Address - Zip Code:46148-9592
Practice Address - Country:US
Practice Address - Phone:765-345-2188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-29
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12009979OtherSTATE LICENSE
IN1578637872OtherNPI