Provider Demographics
NPI:1457025785
Name:PENCE FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:PENCE FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-752-6087
Mailing Address - Street 1:9744 LANTERN RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9612
Mailing Address - Country:US
Mailing Address - Phone:317-842-2337
Mailing Address - Fax:
Practice Address - Street 1:9744 LANTERN RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9612
Practice Address - Country:US
Practice Address - Phone:317-842-2337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental