Healthcare Provider Details

I. General information

NPI: 1861871170
Provider Name (Legal Business Name): MERCY SEAT DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 COMMERCE DRIVE
BLUFFTON IN
46714
US

IV. Provider business mailing address

2155 COMMERCE DRIVE
BLUFFTON IN
46714
US

V. Phone/Fax

Practice location:
  • Phone: 260-823-3328
  • Fax: 260-353-1555
Mailing address:
  • Phone: 260-823-3328
  • Fax: 260-353-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. NKECHI AWELE WAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 260-823-3328