Provider Demographics
NPI:1770828220
Name:GEORGETOWN DENTAL
Entity Type:Organization
Organization Name:GEORGETOWN DENTAL
Other - Org Name:CHERIE Y. SEDWICK, DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:YUEN
Authorized Official - Last Name:SEDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-923-8849
Mailing Address - Street 1:1033 N LUTHER RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-9123
Mailing Address - Country:US
Mailing Address - Phone:812-923-8849
Mailing Address - Fax:812-923-1092
Practice Address - Street 1:1033 N LUTHER RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-9123
Practice Address - Country:US
Practice Address - Phone:812-923-8849
Practice Address - Fax:812-923-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010647122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty