Provider Demographics
NPI:1891218137
Name:TURTLE TOWN DENTAL LLC
Entity Type:Organization
Organization Name:TURTLE TOWN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:UEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-434-0777
Mailing Address - Street 1:210 W WHITLEY ST
Mailing Address - Street 2:
Mailing Address - City:CHURUBUSCO
Mailing Address - State:IN
Mailing Address - Zip Code:46723-1720
Mailing Address - Country:US
Mailing Address - Phone:260-693-3921
Mailing Address - Fax:260-693-1376
Practice Address - Street 1:210 W WHITLEY ST
Practice Address - Street 2:
Practice Address - City:CHURUBUSCO
Practice Address - State:IN
Practice Address - Zip Code:46723-1720
Practice Address - Country:US
Practice Address - Phone:260-693-3921
Practice Address - Fax:260-693-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007976261QD0000X
IN12010006261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1992783294Medicaid
IN1447372362Medicaid