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General NPI Number Information
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NPI Number | 1346800463
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Entity Type | Organization
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Legal Business Name | B AND B DENTAL GROUP, LLC D/B/A KESSLER FAMILY DENTAL AND ASSOCIATES
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 9161 E 109TH AVE
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City | CROWN POINT
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State | IN
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Zip | 46307-8677
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Country | US
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Telephone | 219-576-7958
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Fax |
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Provider Business Mailing Address
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Address Line | 9161 E 109TH AVE
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City | CROWN POINT
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State | IN
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Zip | 46307-8677
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Country | US
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Telephone | 219-576-7958
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ELIAS ARTHUR MACIS
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Credential | DMD
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Telephone | 219-308-2694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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