Provider Demographics
NPI:1063941714
Name:FRANKLIN DENTAL CARE, PC
Entity type:Organization
Organization Name:FRANKLIN DENTAL CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-736-9546
Mailing Address - Street 1:884 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2120
Mailing Address - Country:US
Mailing Address - Phone:317-736-9546
Mailing Address - Fax:
Practice Address - Street 1:884 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2120
Practice Address - Country:US
Practice Address - Phone:317-736-9546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012165A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201243550Medicaid