Provider Demographics
NPI:1881840049
Name:ANDERSON DENTAL CTR
Entity Type:Organization
Organization Name:ANDERSON DENTAL CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:METZNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-649-4995
Mailing Address - Street 1:1537 S SCATTERFIELD RD STE C
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-5783
Mailing Address - Country:US
Mailing Address - Phone:765-649-4995
Mailing Address - Fax:765-683-9126
Practice Address - Street 1:1537 S SCATTERFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5783
Practice Address - Country:US
Practice Address - Phone:765-649-4995
Practice Address - Fax:765-683-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty