Provider Demographics
NPI:1295464782
Name:BADELL DENTAL CLINIC LLC
Entity Type:Organization
Organization Name:BADELL DENTAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-772-3666
Mailing Address - Street 1:1800 S US HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-8681
Mailing Address - Country:US
Mailing Address - Phone:574-248-0456
Mailing Address - Fax:574-772-5643
Practice Address - Street 1:1800 S US HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-8681
Practice Address - Country:US
Practice Address - Phone:574-248-0456
Practice Address - Fax:574-772-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental