Provider Demographics
NPI:1699760280
Name:ASSOCIATES IN FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:ASSOCIATES IN FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOOHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-272-2700
Mailing Address - Street 1:7800 E US 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7156
Mailing Address - Country:US
Mailing Address - Phone:317-272-2700
Mailing Address - Fax:317-272-2785
Practice Address - Street 1:7800 E US 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7156
Practice Address - Country:US
Practice Address - Phone:317-272-2700
Practice Address - Fax:317-272-2785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty