| Southern Indiana Pediatric Dentistry, Llc | |
|
828 S Auto Mall Rd Bloomington IN 47401-5430 | |
| (812) 333-5437 | |
| (812) 333-6305 |
| Full Name | Southern Indiana Pediatric Dentistry, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 828 S Auto Mall Rd, Bloomington, Indiana |
| Authorized Official Name and Position | Matthew L Rasche (OWNER/MEMBER) |
| Authorized Official Contact | 8126610612 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Indiana Pediatric Dentistry, Llc 828 S Auto Mall Rd Bloomington IN 47401-5430 Ph: (812) 333-5437 | Southern Indiana Pediatric Dentistry, Llc 828 S Auto Mall Rd Bloomington IN 47401-5430 Ph: (812) 333-5437 |
| NPI Number | 1356634471 |
|---|---|
| Provider Enumeration Date | 05/23/2011 |
| Last Update Date | 11/22/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356634471 | NPI | - | NPPES |
| 201019080 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 12011284A (Indiana) | Primary |
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