Healthcare Provider Details

I. General information

NPI: 1003345216
Provider Name (Legal Business Name): SPRINGER DENTAL CARE OF MILLERSBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 N BENTON ST
MILLERSBURG IN
46543-9732
US

IV. Provider business mailing address

3702 E MISHAWAKA RD
ELKHART IN
46517-3550
US

V. Phone/Fax

Practice location:
  • Phone: 574-642-4449
  • Fax: 574-642-3863
Mailing address:
  • Phone: 574-971-1532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12011803A
License Number StateIN

VIII. Authorized Official

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