Provider Demographics
NPI:1952915027
Name:VDP OKATIE LLC
Entity type:Organization
Organization Name:VDP OKATIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER OF PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:260-312-5794
Mailing Address - Street 1:3919 AMSTATE RD
Mailing Address - Street 2:
Mailing Address - City:LEO
Mailing Address - State:IN
Mailing Address - Zip Code:46765
Mailing Address - Country:US
Mailing Address - Phone:260-312-5794
Mailing Address - Fax:260-627-5825
Practice Address - Street 1:10 WILLIAM POPE DRIVE, SUITE #2
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909
Practice Address - Country:US
Practice Address - Phone:843-705-7066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty