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General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1629279104

Individual Registrant:
Gender: M
Sole Proprietor

Location and contact information for practice:
200 GRANDVIEW DR  SALEM, IN 47167-1022 US
Tel: 812-883-1999  Fax: 812-883-7099

Contact information for business:
200 GRANDVIEW DR  SALEM, IN 47167-1022 US
Tel: 812-883-1999  Fax: 812-883-7099

Registration Information:
NPI: 1629279104
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
General Practice

Legacy codes, insurance codes and state license numbers:



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