Provider Demographics
NPI:1538682869
Name:FAMILY & IMPLANT DENTISTRY OF DALE, LLC
Entity Type:Organization
Organization Name:FAMILY & IMPLANT DENTISTRY OF DALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FRIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-937-4818
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:DALE
Mailing Address - State:IN
Mailing Address - Zip Code:47523-0465
Mailing Address - Country:US
Mailing Address - Phone:812-937-4818
Mailing Address - Fax:
Practice Address - Street 1:110 W HAMMOND ST
Practice Address - Street 2:
Practice Address - City:DALE
Practice Address - State:IN
Practice Address - Zip Code:47523-8965
Practice Address - Country:US
Practice Address - Phone:812-937-4818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008787A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental