Provider Demographics
NPI:1508236399
Name:THE KIDS' DENTIST, PC
Entity Type:Organization
Organization Name:THE KIDS' DENTIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMMI
Authorized Official - Middle Name:
Authorized Official - Last Name:FROEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-362-5437
Mailing Address - Street 1:108 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1950
Mailing Address - Country:US
Mailing Address - Phone:765-362-5437
Mailing Address - Fax:765-362-1652
Practice Address - Street 1:108 N OAK ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1950
Practice Address - Country:US
Practice Address - Phone:765-362-5437
Practice Address - Fax:765-362-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008572A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty