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General NPI Number Information
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NPI Number | 1184882219
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Entity Type | Organization
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Legal Business Name | ADOLESCENT & PEDIACTRIC DENTISTRY P.C.
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 610 S TILLOTSON AVE STE 205
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City | MUNCIE
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State | IN
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Zip | 47304-4450
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Country | US
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Telephone | 765-288-5527
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Fax | 765-288-6119
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Provider Business Mailing Address
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Address Line | 610 S TILLOTSON AVE STE 205
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City | MUNCIE
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State | IN
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Zip | 47304-4450
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Country | US
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Telephone | 765-288-5527
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Fax | 765-288-6119
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL RICHARD MUSAL
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Credential | D.D.S.
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Telephone | 765-288-5527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12010472A
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License Number State | IN
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