Provider Demographics
NPI:1346663044
Name:ANGOLA FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:ANGOLA FAMILY DENTISTRY, LLC
Other - Org Name:GABET FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:GABET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-665-3637
Mailing Address - Street 1:901 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-1167
Mailing Address - Country:US
Mailing Address - Phone:260-665-3637
Mailing Address - Fax:260-665-6142
Practice Address - Street 1:901 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1167
Practice Address - Country:US
Practice Address - Phone:260-665-3637
Practice Address - Fax:260-665-6142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011130A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty