Provider Demographics
NPI:1639870363
Name:CVILLE DENTAL LLC
Entity Type:Organization
Organization Name:CVILLE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-491-5095
Mailing Address - Street 1:1950 INDIANAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-3135
Mailing Address - Country:US
Mailing Address - Phone:765-364-1740
Mailing Address - Fax:
Practice Address - Street 1:1950 INDIANAPOLIS RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-3135
Practice Address - Country:US
Practice Address - Phone:765-364-1740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental