NPI 1003210204

A L Dehaven DDS LLC

Organisation Dentist Scottsburg, IN

Practice location

Address: 1366 N Gardner St Box 330, Scottsburg, IN 47170-7793
Phone: (812) 752-3524
Fax: (812) 752-9195
Mailing address: 3225 Nichol Ave, Anderson, IN 46011-3148

Authorised official

Name: Angela L Dehaven
Title: Owner
Phone: (765) 623-6751

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence 12009405 (IN)

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Registry record

NPI: 1003210204
Entity type: Organization
NPI issued: 16 Oct 2014
Record last updated: 16 Oct 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.