Provider Demographics
NPI:1952824047
Name:FAMILY & IMPLANT DENTISTRY HUNTINGBURG LLC
Entity Type:Organization
Organization Name:FAMILY & IMPLANT DENTISTRY HUNTINGBURG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FRIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-683-5810
Mailing Address - Street 1:1411 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9341
Mailing Address - Country:US
Mailing Address - Phone:812-683-5810
Mailing Address - Fax:
Practice Address - Street 1:1411 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9341
Practice Address - Country:US
Practice Address - Phone:812-683-5810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008787A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental