Provider Demographics
NPI:1891085775
Name:CDP LLC
Entity Type:Organization
Organization Name:CDP LLC
Other - Org Name:CLARKSVILLE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:812-725-9200
Mailing Address - Street 1:529 E LEWIS AND CLARK PKWY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-1729
Mailing Address - Country:US
Mailing Address - Phone:812-725-9200
Mailing Address - Fax:812-725-9313
Practice Address - Street 1:529 E LEWIS AND CLARK PKWY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-1729
Practice Address - Country:US
Practice Address - Phone:812-725-9200
Practice Address - Fax:812-725-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty