Provider Demographics
NPI:1700444387
Name:BROWNSBURG FAMILY DENTISTRY ASSOCIATES
Entity Type:Organization
Organization Name:BROWNSBURG FAMILY DENTISTRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:OPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-225-4520
Mailing Address - Street 1:1460 N GREEN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7488
Mailing Address - Country:US
Mailing Address - Phone:317-225-5251
Mailing Address - Fax:
Practice Address - Street 1:1460 N GREEN ST STE 300
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7488
Practice Address - Country:US
Practice Address - Phone:317-225-5251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty