Provider Demographics
NPI:1285853028
Name:INDIANA FAMILY DENTISTRY, L.L.C.
Entity Type:Organization
Organization Name:INDIANA FAMILY DENTISTRY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:HINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-852-5999
Mailing Address - Street 1:505 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1026
Mailing Address - Country:US
Mailing Address - Phone:317-852-5999
Mailing Address - Fax:317-852-6624
Practice Address - Street 1:505 N GREEN ST
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1026
Practice Address - Country:US
Practice Address - Phone:317-852-5999
Practice Address - Fax:317-852-6624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120098701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty