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NPI Code Detail

MEDICARE: ARCH COMPLETE FAMILY DENTAL GROUP, INC.

MEDICARE: ARCH COMPLETE FAMILY DENTAL GROUP, INC.
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1831601566
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARCH COMPLETE FAMILY DENTAL GROUP, INC.
Provider Business Mailing Address
First Line : 123 E 113TH AVE
Second Line :
City : CROWN POINT
State : IN
Zip : 46307-9706
Country : US
Telephone Number : 219-310-8807
Fax Number : 219-779-9437
Provider Business Practice Location Address
First Line : 123 E 113TH AVE
Second Line :
City : CROWN POINT
State : IN
Zip : 46307-9706
Country : US
Telephone Number : 219-310-8807
Fax Number : 219-779-9437
Authorized Official
Title or Position : PRESIDENT
Name : JUSTYN ANTHONY ARCH
Credential :
Telephone Number : 219-310-8807
Provider Enumeration Date : 11/03/2017
Last Update Date : 11/03/2017

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Directions to “ARCH COMPLETE FAMILY DENTAL GROUP, INC. ” Practice Location

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