| Ellettsville Gentle Dentist | |
|
3617 W State Road 46 Bloomington IN 47404-9152 | |
| (812) 876-0007 | |
| Not Available |
| Full Name | Ellettsville Gentle Dentist |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3617 W State Road 46, Bloomington, Indiana |
| Authorized Official Name and Position | Jennifer Purvis (AR MANAGER) |
| Authorized Official Contact | 3173593888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellettsville Gentle Dentist 3617 W State Road 46 Bloomington IN 47404-9152 Ph: (812) 876-0007 | Ellettsville Gentle Dentist 3617 W State Road 46 Bloomington IN 47404-9152 Ph: (812) 876-0007 |
| NPI Number | 1609190719 |
|---|---|
| Provider Enumeration Date | 03/18/2010 |
| Last Update Date | 03/18/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609190719 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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