Provider Demographics
NPI:1649070699
Name:PITTSBORO FAMILY DENTISTRY CAMPBELL LLC
Entity type:Organization
Organization Name:PITTSBORO FAMILY DENTISTRY CAMPBELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL OPERATIONS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:TENNILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-370-1158
Mailing Address - Street 1:954 BERKHAMSTED LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3683
Mailing Address - Country:US
Mailing Address - Phone:706-346-7944
Mailing Address - Fax:
Practice Address - Street 1:204 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:IN
Practice Address - Zip Code:46167-9164
Practice Address - Country:US
Practice Address - Phone:706-346-7944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental