Provider Demographics
NPI:1194235036
Name:MONTPELIER FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:MONTPELIER FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANSECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-728-2811
Mailing Address - Street 1:108 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:IN
Mailing Address - Zip Code:47359-1132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:IN
Practice Address - Zip Code:47359-1132
Practice Address - Country:US
Practice Address - Phone:765-728-2811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental