Provider Demographics
NPI:1740556851
Name:SHELBYVILLE FAMILY DENTAL
Entity Type:Organization
Organization Name:SHELBYVILLE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-398-6399
Mailing Address - Street 1:122 LEE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-3403
Mailing Address - Country:US
Mailing Address - Phone:317-398-6399
Mailing Address - Fax:317-398-6362
Practice Address - Street 1:122 LEE BOULEVARD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-3403
Practice Address - Country:US
Practice Address - Phone:317-398-6399
Practice Address - Fax:317-398-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011144A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty