Healthcare Provider Details

I. General information

NPI: 1497352173
Provider Name (Legal Business Name): SPRINGER DENTAL CARE AT KEYSTONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 CHARLTON CT
GOSHEN IN
46526-6463
US

IV. Provider business mailing address

3702 E MISHAWAKA RD
ELKHART IN
46517-3550
US

V. Phone/Fax

Practice location:
  • Phone: 574-533-5925
  • Fax:
Mailing address:
  • Phone: 574-971-1532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TROY SPRINGER
Title or Position: OWNER
Credential: D.M.D.
Phone: 574-971-1532