Provider Demographics
NPI:1295912087
Name:AVON DENTAL CENTRE
Entity type:Organization
Organization Name:AVON DENTAL CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-272-8100
Mailing Address - Street 1:7517 BEECHWOOD CENTRE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7852
Mailing Address - Country:US
Mailing Address - Phone:317-272-8100
Mailing Address - Fax:317-272-0276
Practice Address - Street 1:7517 BEECHWOOD CENTRE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7852
Practice Address - Country:US
Practice Address - Phone:317-272-8100
Practice Address - Fax:317-272-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12019458122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty