Provider Demographics
NPI:1790849313
Name:DENNIS L CHURCH DDS INC
Entity Type:Organization
Organization Name:DENNIS L CHURCH DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-552-0211
Mailing Address - Street 1:213 NORTH 16TH ST
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036
Mailing Address - Country:US
Mailing Address - Phone:765-552-0211
Mailing Address - Fax:765-552-5106
Practice Address - Street 1:213 NORTH 16TH ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036
Practice Address - Country:US
Practice Address - Phone:765-552-0211
Practice Address - Fax:765-552-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007767A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental