Provider Demographics
NPI:1558528117
Name:MCFADDEN FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:MCFADDEN FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-342-3232
Mailing Address - Street 1:509 STATE ROAD 39 BYP S
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1972
Mailing Address - Country:US
Mailing Address - Phone:765-342-3232
Mailing Address - Fax:765-342-3291
Practice Address - Street 1:509 STATE ROAD 39 BYP S
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1972
Practice Address - Country:US
Practice Address - Phone:765-342-3232
Practice Address - Fax:765-342-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010102A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty