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General NPI Number Information
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NPI Number | 1376141168
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Entity Type | Organization
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Legal Business Name | LODS OF SMILES FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 110 E YORK ST
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City | ROCKVILLE
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State | IN
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Zip | 47872-1732
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Country | US
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Telephone | 740-703-6689
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Fax |
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Provider Business Mailing Address
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Address Line | 5101 N BROADWAY AVE
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City | MUNCIE
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State | IN
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Zip | 47303-6300
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Country | US
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Telephone | 740-703-6689
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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. CRAIG S LODS
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Credential | DDS
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Telephone | 740-703-6689
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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 |
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License Number State |
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