Healthcare Provider Details

I. General information

NPI: 1144818055
Provider Name (Legal Business Name): HOBART AND LAKE COUNTY FAMILY DENTAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N WISCONSIN ST
HOBART IN
46342-2160
US

IV. Provider business mailing address

407 N WISCONSIN ST
HOBART IN
46342-2160
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-4624
  • Fax:
Mailing address:
  • Phone: 219-942-4624
  • 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: KELLY WEBER
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 574-232-2992