Provider Demographics
NPI:1811159700
Name:MEC DENTAL I, P.C.
Entity type:Organization
Organization Name:MEC DENTAL I, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:317-336-6723
Mailing Address - Street 1:114 LEE BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-3403
Mailing Address - Country:US
Mailing Address - Phone:317-398-6399
Mailing Address - Fax:
Practice Address - Street 1:114 LEE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-3403
Practice Address - Country:US
Practice Address - Phone:317-398-6399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010045A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty