Provider Demographics
NPI:1477765022
Name:DENTAL CARE ACTION INC
Entity Type:Organization
Organization Name:DENTAL CARE ACTION INC
Other - Org Name:DENTAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-339-5015
Mailing Address - Street 1:1602 W THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404
Mailing Address - Country:US
Mailing Address - Phone:812-339-7700
Mailing Address - Fax:812-339-7794
Practice Address - Street 1:1602 W THIRD STREET
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404
Practice Address - Country:US
Practice Address - Phone:812-339-7700
Practice Address - Fax:812-339-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10850A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty