Brazil Dental Center, Llc | |
21 N Washington St Brazil IN 47834-2204 | |
(812) 448-3639 | |
Not Available |
Full Name | Brazil Dental Center, Llc |
---|---|
Speciality | Clinic/center - Dental |
Location | 21 N Washington St, Brazil, Indiana |
Authorized Official Name and Position | Tyler Richey (OWNER) |
Authorized Official Contact | 8124483639 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Brazil Dental Center, Llc 21 N Washington St Brazil IN 47834-2204 Ph: (812) 448-3639 | Brazil Dental Center, Llc 21 N Washington St Brazil IN 47834-2204 Ph: (812) 448-3639 |
NPI Number | 1528542370 |
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Provider Enumeration Date | 09/18/2018 |
Last Update Date | 09/18/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1528542370 | NPI | - | NPPES |
201229120B | Medicaid | IN | |
300004053 | Medicaid | IN | |
201234800A | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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