Provider Demographics
NPI:1174622658
Name:CLICK, JOHN PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:CLICK
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 1:212 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47145-4900
Mailing Address - Country:US
Mailing Address - Phone:812-633-4209
Mailing Address - Fax:812-633-4451
Practice Address - Street 1:6868 OLD VINCENNES RD
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9400
Practice Address - Country:US
Practice Address - Phone:812-633-4209
Practice Address - Fax:812-633-4451
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120088471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice