Provider Demographics
NPI:1508889890
Name:BROWNSBURG FAMILY DENTAL CARE, INC.
Entity Type:Organization
Organization Name:BROWNSBURG FAMILY DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:RUPERT
Authorized Official - Last Name:EDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-852-4593
Mailing Address - Street 1:8 MOTIF BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1017
Mailing Address - Country:US
Mailing Address - Phone:317-852-4593
Mailing Address - Fax:317-852-1095
Practice Address - Street 1:8 MOTIF BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1017
Practice Address - Country:US
Practice Address - Phone:317-852-4593
Practice Address - Fax:317-852-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009188B1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty