Provider Demographics
NPI:1972269421
Name:DEE FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:DEE FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-401-0581
Mailing Address - Street 1:3200 SYCAMORE CT STE 1C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1545
Mailing Address - Country:US
Mailing Address - Phone:812-379-9211
Mailing Address - Fax:
Practice Address - Street 1:3200 SYCAMORE CT STE 1C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-1545
Practice Address - Country:US
Practice Address - Phone:812-379-9211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEE FAMILY DENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1417244815OtherNPI TYPE 1
IN12011686AOtherIN DENTAL LICENSE