Provider Demographics
NPI:1821273533
Name:PEBBLE BROOK DENTISTRY LLC
Entity Type:Organization
Organization Name:PEBBLE BROOK DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOHR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-896-1515
Mailing Address - Street 1:5713 PEBBLE VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-7373
Mailing Address - Country:US
Mailing Address - Phone:317-896-1515
Mailing Address - Fax:
Practice Address - Street 1:5713 PEBBLE VILLAGE LN
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7373
Practice Address - Country:US
Practice Address - Phone:317-896-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010838A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty