Provider Demographics
NPI:1760590517
Name:AUGUST M. NATALIE DDS FAGD & ANTHONY S NATALIE DDS, LLC
Entity Type:Organization
Organization Name:AUGUST M. NATALIE DDS FAGD & ANTHONY S NATALIE DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:SCOT
Authorized Official - Last Name:NATALIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-839-2381
Mailing Address - Street 1:148 VESTAL RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-1277
Mailing Address - Country:US
Mailing Address - Phone:317-839-2381
Mailing Address - Fax:817-839-0297
Practice Address - Street 1:148 VESTAL RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-1277
Practice Address - Country:US
Practice Address - Phone:317-839-2381
Practice Address - Fax:817-839-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty