Healthcare Provider Details

I. General information

NPI: 1740446939
Provider Name (Legal Business Name): HARRINGTON ORTHODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S. COLUMBIA ST.
SOUTH BEND IN
46601-2301
US

IV. Provider business mailing address

350 S. COLUMBIA ST.
SOUTH BEND IN
46601-2301
US

V. Phone/Fax

Practice location:
  • Phone: 574-233-7444
  • Fax: 574-233-7273
Mailing address:
  • Phone: 574-233-7444
  • Fax: 574-233-7273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12010498A
License Number StateIN

VIII. Authorized Official

Name: DR. CHAD FULTON HARRINGTON
Title or Position: OWNER
Credential: DDS, MSD
Phone: 574-233-7444