Provider Demographics
NPI:1992154587
Name:JP DENTAL - RICHMOND LLC
Entity type:Organization
Organization Name:JP DENTAL - RICHMOND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PASICZNYK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-818-7777
Mailing Address - Street 1:894 SIM HODGIN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1931
Mailing Address - Country:US
Mailing Address - Phone:765-962-3713
Mailing Address - Fax:
Practice Address - Street 1:894 SIM HODGIN PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1931
Practice Address - Country:US
Practice Address - Phone:765-962-3713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVOLUTION DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty