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2241 State St Ste C New Albany IN 47150-4949 | |
| (812) 945-5100 | |
| (812) 945-5101 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2241 State St Ste C, New Albany, Indiana |
| Authorized Official Name and Position | Kenneth G Dale (OWNER) |
| Authorized Official Contact | 8129455100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2241 State St Ste C New Albany IN 47150-4949 Ph: (812) 945-5100 | 2241 State St Ste C New Albany IN 47150-4949 Ph: (812) 945-5100 |
| NPI Number | 1689049561 |
|---|---|
| Provider Enumeration Date | 12/03/2015 |
| Last Update Date | 12/03/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689049561 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 12009112 (Indiana) | Primary |
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