A L Dehaven DDS LLC

NPI #1003210204 in Scottsburg, Indiana

Provider Information

NPI Number: 1003210204
Entity Type: Organization
Organization Name: A L Dehaven DDS LLC
Primary Specialty: Dentist
Enumeration Date: Oct 16, 2014
Last Updated: Oct 16, 2014

Practice Location

Address: 1366 N GARDNER ST
Address 2: BOX 330
City: Scottsburg
State: Indiana
ZIP Code: 47170-7793
Phone: (812) 752-3524

Authorized Official

Name: DR. ANGELA L DEHAVEN, DDS
Title: OWNER
Phone: (765) 623-6751

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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