Provider Demographics
NPI:1669927786
Name:DENTAL SAFARI CO INDIANA, LLC
Entity type:Organization
Organization Name:DENTAL SAFARI CO INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-559-6654
Mailing Address - Street 1:P.O. BOX 2314
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902
Mailing Address - Country:US
Mailing Address - Phone:618-993-8333
Mailing Address - Fax:618-993-8335
Practice Address - Street 1:1634 E NORTHFIELD DR., STE 500
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112
Practice Address - Country:US
Practice Address - Phone:618-993-8333
Practice Address - Fax:618-993-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201382420AMedicaid