MEDICARE: SELECT DENTISTRY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12010354A	IN

General Provider Information

NPI Number	:	1811186323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELECT DENTISTRY, PC

Provider Business Mailing Address
First Line	:	1422 LINCOLN WAY E
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46613-3250
Country	:	US
Telephone Number	:	574-232-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 LINCOLN WAY E
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46613-3250
Country	:	US
Telephone Number	:	574-232-8888
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID MICHAEL FOLLIS
Credential	:	DDS
Telephone Number	:	574-514-8746

Provider Enumeration Date	:	10/21/2007
Last Update Date	:	10/21/2007

Similar Medicare Providers

1457345688 — DR. DAVID M. FOLLIS D.D.S.
Practice Location Address:

1422 LINCOLN WAY E
SOUTH BEND, IN
46613-3250

Practice Phone: 574-232-8888
Practice Fax: 574-232-8929

1457850687 — SELECT DENTAL ASSOCIATES PC
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46613-3250

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1396101812 — JOSEPH RYAN BAIRD BCBA
Practice Location Address:

750 LINCOLN WAY E
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Practice Phone: 574-786-0088
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1548626963 — SHELLEY GORSKI BCABA, NCC
Practice Location Address:

750 LINCOLN WAY E
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46601-3250

Practice Phone: 574-786-0088
Practice Fax:

1356005599 — ADAPTIVE SOLUTIONS, LLC
Practice Location Address:

750 LINCOLN WAY E
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1629878376 — JILLIAN MILLER RBT
Practice Location Address:

750 LINCOLN WAY E
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46601-3250

Practice Phone: 574-786-0088
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