Provider Demographics
NPI:1194072330
Name:OCFD MANAGEMENT, LLC
Entity type:Organization
Organization Name:OCFD MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:VAN EMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-723-3959
Mailing Address - Street 1:1570 W HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:IN
Mailing Address - Zip Code:47454-9666
Mailing Address - Country:US
Mailing Address - Phone:812-723-3959
Mailing Address - Fax:812-723-3909
Practice Address - Street 1:1570 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-9666
Practice Address - Country:US
Practice Address - Phone:812-723-3959
Practice Address - Fax:812-723-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010908A1223G0001X
IN12007674A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty