Provider Demographics
NPI:1679797153
Name:FRANKLIN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:FRANKLIN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-736-6361
Mailing Address - Street 1:1035 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2123
Mailing Address - Country:US
Mailing Address - Phone:317-736-6361
Mailing Address - Fax:
Practice Address - Street 1:1035 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2123
Practice Address - Country:US
Practice Address - Phone:317-736-6361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120087911223G0001X
IN120101991223G0001X
IN120099431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12009943OtherKIM ALEXANDER LICENSE
IN12010199OtherNELL THOMPSON LICENSE
IN12008791OtherSHARON HALEY LICENSE