A L Dehaven DDS LLC

Primary specialty

DentistTaxonomy code 122300000X

License

12009405 Issued in IN

Legal business name

A L DEHAVEN DDS LLC

Practice address

1366 N Gardner St
Box 330
Scottsburg, IN 47170-7793

Phone

(812) 752-3524

Fax

(812) 752-9195

NPI assigned

Oct 16, 2014

Last updated

Oct 16, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Angela L Dehaven, DDSNPI 1649304965

Title

Owner

Phone

(765) 623-6751

Specialties & licenses 1

Addresses

Tax ID family

A L Dehaven DDS LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• A L Dehaven DDS LLC

  • Dentist
  • Scottsburg, IN
  • NPI 1952705931
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Angela Lynn Dehaven, DDS

  • Dentist
  • Anderson, IN
  • NPI 1649304965
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413417600000",
    "number": "1003210204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 NICHOL AVE",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460113148",
            "telephone_number": "765-642-7717",
            "fax_number": "765-649-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1366 N GARDNER ST",
            "address_2": "BOX 330",
            "city": "SCOTTSBURG",
            "state": "IN",
            "postal_code": "471707793",
            "telephone_number": "812-752-3524",
            "fax_number": "812-752-9195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A L DEHAVEN DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-16",
        "last_updated": "2014-10-16",
        "status": "A",
        "authorized_official_last_name": "DEHAVEN",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-623-6751",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12009405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 1St Place Health LLC
• A L Dehaven DDS LLC
• Karen Amick, FNP
• Jason Anderson, LMT
• Assocaites in Pedicatric Therapy
• Shane A Avery, MD

• Dentist in Scottsburg, IN
• Providers in Scottsburg, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.