Provider Demographics
NPI:1457484420
Name:WHITE ORCHID DENTAL LLP
Entity Type:Organization
Organization Name:WHITE ORCHID DENTAL LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOGOLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-9122
Mailing Address - Street 1:548 RIDGE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1722
Mailing Address - Country:US
Mailing Address - Phone:219-836-9122
Mailing Address - Fax:219-836-9123
Practice Address - Street 1:548 RIDGE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1722
Practice Address - Country:US
Practice Address - Phone:219-836-9122
Practice Address - Fax:219-836-9123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty