Provider Demographics
NPI:1588740815
Name:INMAN, JED MARLIN (DDS)
Entity type:Individual
Prefix:MR
First Name:JED
Middle Name:MARLIN
Last Name:INMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-8601
Mailing Address - Country:US
Mailing Address - Phone:812-897-4889
Mailing Address - Fax:812-897-8113
Practice Address - Street 1:800 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-8601
Practice Address - Country:US
Practice Address - Phone:812-897-4889
Practice Address - Fax:812-897-8113
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN76131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice