Provider Demographics
NPI:1740718980
Name:ELWOOD FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:ELWOOD FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFEVRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-756-7125
Mailing Address - Street 1:16426 CHALET CIR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8781
Mailing Address - Country:US
Mailing Address - Phone:317-756-7125
Mailing Address - Fax:
Practice Address - Street 1:213 N 16TH ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-1769
Practice Address - Country:US
Practice Address - Phone:765-552-7803
Practice Address - Fax:765-552-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty