Provider Demographics
NPI:1689088601
Name:ADVANCED DENTAL CARE OF ANDERSON LLC
Entity Type:Organization
Organization Name:ADVANCED DENTAL CARE OF ANDERSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ELBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-622-7000
Mailing Address - Street 1:1612 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-2826
Mailing Address - Country:US
Mailing Address - Phone:765-622-7000
Mailing Address - Fax:765-622-9642
Practice Address - Street 1:1612 E 53RD ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-2826
Practice Address - Country:US
Practice Address - Phone:765-622-7000
Practice Address - Fax:765-622-9642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010047A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200283200Medicaid