Provider Demographics
NPI:1710129580
Name:DENTAL HEALTH ASSOC OF IN
Entity Type:Organization
Organization Name:DENTAL HEALTH ASSOC OF IN
Other - Org Name:WESTFIELD GENTLE DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-359-3888
Mailing Address - Street 1:17419 CAREY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9439
Mailing Address - Country:US
Mailing Address - Phone:317-896-8734
Mailing Address - Fax:317-896-9343
Practice Address - Street 1:17419 CAREY RD
Practice Address - Street 2:SUITE B
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9439
Practice Address - Country:US
Practice Address - Phone:317-896-8734
Practice Address - Fax:317-896-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty