Provider Demographics
NPI:1588289169
Name:VDP WABASH LLC
Entity type:Organization
Organization Name:VDP WABASH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER OF BUSINESS
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:260-563-4065
Mailing Address - Street 1:278 MANCHESTER AVE.
Mailing Address - Street 2:278 MANCHESTER AVE.
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992
Mailing Address - Country:US
Mailing Address - Phone:260-563-4065
Mailing Address - Fax:260-563-4193
Practice Address - Street 1:278 MANCHESTER AVE.
Practice Address - Street 2:278 MANCHESTER AVE.
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992
Practice Address - Country:US
Practice Address - Phone:260-563-4065
Practice Address - Fax:260-563-4193
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VDP WABASH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty