Healthcare Provider Details

I. General information

NPI: 1326162132
Provider Name (Legal Business Name): DENTAL CENTER (MERRILLVILLE) P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W 86TH AVE STE A
MERRILLVILLE IN
46410-6192
US

IV. Provider business mailing address

155 W 86TH AVE STE A
MERRILLVILLE IN
46410-6192
US

V. Phone/Fax

Practice location:
  • Phone: 219-685-8665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MIKE COLE
Title or Position: INSURANCE DIRECTOR
Credential:
Phone: 727-726-1611