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ADVANCED DENTAL CARE OF ANDERSON LLC

General Practice Dentist

Anderson, Indiana

Provider NPI: 1689088601

Organization Information:
Organization Name:  ADVANCED DENTAL CARE OF ANDERSON LLC
Organization is not Subpart
Authorized Official:  JAMES PATRICK ELBRECHT  DENTIST  765-6227000

Practice Location:
1612 E 53RD ST  ANDERSON, IN 46013 US
Tel: 765-622-7000  Fax: 765-622-9642

Business Mailing Address:
1612 E 53RD ST  ANDERSON, IN 46013 US
Tel: 765-622-7000  Fax: 765-622-9642

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
IN12010047A

Other Provider Identifiers:

IssuerNumberStateType
200283200IN05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin



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