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114 Lee Blvd Suite E Shelbyville IN 46176-3403 | |
| (317) 398-6399 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 114 Lee Blvd, Shelbyville, Indiana |
| Authorized Official Name and Position | Matthew Edward Church (OWNER/PRESIDENT) |
| Authorized Official Contact | 3173366723 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
114 Lee Blvd Suite E Shelbyville IN 46176-3403 Ph: (317) 398-6399 | 114 Lee Blvd Suite E Shelbyville IN 46176-3403 Ph: (317) 398-6399 |
| NPI Number | 1811159700 |
|---|---|
| Provider Enumeration Date | 07/01/2008 |
| Last Update Date | 07/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811159700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 12010045A (Indiana) | Primary |
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