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General NPI Number Information
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NPI Number | 1366999070
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Entity Type | Organization
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Legal Business Name | UNITED DENTAL CENTERS
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Dates
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Enumeration Date | 09/10/2016
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Last Update Date | 09/10/2016
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Provider Practice Location Address
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Address Line | 5655 HARRISON
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City | MERRILLVILLE
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State | IN
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Zip | 46410
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Country | US
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Telephone | 219-980-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 5655 HARRISON
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City | MERRILLVILLE
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State | IN
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Zip | 46410
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Country | US
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Telephone | 219-980-4900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH FRIED
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Credential | DDS
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Telephone | 219-980-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12009827A
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License Number State | IN
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