Provider Demographics
NPI:1427667336
Name:INDIJU 4 DENTAL LLC
Entity type:Organization
Organization Name:INDIJU 4 DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:ALLYN
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-991-8750
Mailing Address - Street 1:245 DUNHAM DR
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-8040
Mailing Address - Country:US
Mailing Address - Phone:717-991-8750
Mailing Address - Fax:717-865-6047
Practice Address - Street 1:4240 OREGEON PK.
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522
Practice Address - Country:US
Practice Address - Phone:717-991-8750
Practice Address - Fax:717-865-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental