Provider Demographics
NPI:1902516370
Name:URGENT DENTAL CENTER ANDERSON LLC
Entity Type:Organization
Organization Name:URGENT DENTAL CENTER ANDERSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-894-0631
Mailing Address - Street 1:1736 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-2447
Mailing Address - Country:US
Mailing Address - Phone:847-894-0631
Mailing Address - Fax:
Practice Address - Street 1:1736 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-2447
Practice Address - Country:US
Practice Address - Phone:317-399-5771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty