Provider Demographics
NPI:1598825770
Name:DENTAL HEALTH ASSOCIATES OF INDIANA
Entity Type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES OF INDIANA
Other - Org Name:AMERICAN FAMILY DENTAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-423-9111
Mailing Address - Street 1:12802 TOWNEPARK WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2308
Mailing Address - Country:US
Mailing Address - Phone:502-423-9111
Mailing Address - Fax:502-423-9330
Practice Address - Street 1:12802 TOWNEPARK WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2308
Practice Address - Country:US
Practice Address - Phone:502-423-9111
Practice Address - Fax:502-423-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty