Provider Demographics
NPI:1881816007
Name:DENTAL PROFESSIONALS OF INDIANA, P.C.
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF INDIANA, P.C.
Other - Org Name:OSCEOLA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOELSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:103 OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561
Mailing Address - Country:US
Mailing Address - Phone:574-674-8757
Mailing Address - Fax:574-674-8490
Practice Address - Street 1:103 OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561
Practice Address - Country:US
Practice Address - Phone:574-674-8757
Practice Address - Fax:574-674-8490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF INDIANA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty