Provider Demographics
NPI:1396486791
Name:TRANSFORMATIVE FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:TRANSFORMATIVE FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-207-1090
Mailing Address - Street 1:814 E RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-3969
Mailing Address - Country:US
Mailing Address - Phone:812-207-1090
Mailing Address - Fax:
Practice Address - Street 1:7301 GEORGETOWN RD STE 113
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-4157
Practice Address - Country:US
Practice Address - Phone:812-207-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental