Provider Demographics
NPI:1710474531
Name:FAMILY DENTAL OF PENDLETON
Entity Type:Organization
Organization Name:FAMILY DENTAL OF PENDLETON
Other - Org Name:NOBLESVILLE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-778-7558
Mailing Address - Street 1:210 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-1047
Mailing Address - Country:US
Mailing Address - Phone:765-778-7558
Mailing Address - Fax:765-778-9000
Practice Address - Street 1:210 E WATER ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-1047
Practice Address - Country:US
Practice Address - Phone:765-778-7558
Practice Address - Fax:765-778-9000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY DENTAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120097221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty