Provider Demographics
NPI:1902272081
Name:HUNTERTOWN DENTAL SERVICES, INC.
Entity Type:Organization
Organization Name:HUNTERTOWN DENTAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BREZAUSEK-SODANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-637-5848
Mailing Address - Street 1:14932 LIMA RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46748-9275
Mailing Address - Country:US
Mailing Address - Phone:260-637-5848
Mailing Address - Fax:260-637-6153
Practice Address - Street 1:14932 LIMA RD
Practice Address - Street 2:
Practice Address - City:HUNTERTOWN
Practice Address - State:IN
Practice Address - Zip Code:46748-9275
Practice Address - Country:US
Practice Address - Phone:260-637-5848
Practice Address - Fax:260-637-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN54000888A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty