Provider Demographics
NPI:1912363953
Name:ACCENT DENTAL
Entity Type:Organization
Organization Name:ACCENT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-465-4008
Mailing Address - Street 1:402 MARQUETTE ST
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2563
Mailing Address - Country:US
Mailing Address - Phone:219-465-4008
Mailing Address - Fax:219-462-0283
Practice Address - Street 1:402 MARQUETTE ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2563
Practice Address - Country:US
Practice Address - Phone:219-465-4008
Practice Address - Fax:219-462-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008773122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty