Provider Demographics
NPI:1275760688
Name:HOOSIER DENTAL CARE LLC
Entity Type:Organization
Organization Name:HOOSIER DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:COST
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-654-2951
Mailing Address - Street 1:301 NORTH WARPATH DRIVE
Mailing Address - Street 2:PO BOX 306
Mailing Address - City:MILAN
Mailing Address - State:IN
Mailing Address - Zip Code:47031-9530
Mailing Address - Country:US
Mailing Address - Phone:812-654-2951
Mailing Address - Fax:812-654-3069
Practice Address - Street 1:301 NORTH WARPATH DRIVE
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IN
Practice Address - Zip Code:47031
Practice Address - Country:US
Practice Address - Phone:812-654-2951
Practice Address - Fax:812-654-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty