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General NPI Number Information
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NPI Number | 1154043297
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Entity Type | Organization
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Legal Business Name | MADE DENTAL PC
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Dates
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Enumeration Date | 09/15/2022
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 2213 MAIN ST UNIT 2B
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City | HIGHLAND
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State | IN
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Zip | 46322-3514
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Country | US
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Telephone | 219-258-7076
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Fax |
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Provider Business Mailing Address
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Address Line | 2213 MAIN ST UNIT 2B
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City | HIGHLAND
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State | IN
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Zip | 46322-3514
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Country | US
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Telephone | 219-258-7076
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY PALLOTTO
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Credential | DDS
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Telephone | 708-228-8224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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