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General NPI Number Information
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NPI Number | 1356156954
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Entity Type | Organization
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Legal Business Name | CROWN POINT PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 1549 S COURT ST STE A
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City | CROWN POINT
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State | IN
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Zip | 46307-4809
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Country | US
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Telephone | 219-305-2773
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Fax |
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Provider Business Mailing Address
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Address Line | 1549 S COURT ST STE A
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City | CROWN POINT
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State | IN
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Zip | 46307-4809
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Country | US
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Telephone | 219-305-2773
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. CLAUDETTE MUNYABERA
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Credential |
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Telephone | 269-267-8033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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