Provider Demographics
NPI:1902649304
Name:BRAZIL FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:BRAZIL FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-443-2541
Mailing Address - Street 1:497 E US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-7745
Mailing Address - Country:US
Mailing Address - Phone:812-443-2541
Mailing Address - Fax:812-446-1045
Practice Address - Street 1:497 E US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-7745
Practice Address - Country:US
Practice Address - Phone:812-443-2541
Practice Address - Fax:812-446-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty