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General NPI Number Information
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NPI Number | 1588703250
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Entity Type | Organization
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Legal Business Name | ASSOCIATED DENTISTS OF NORTHWEST INDIANA PC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 WEST LINCOLN HWY SUITE N
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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 | 219-769-6444
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Fax | 219-755-4790
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Provider Business Mailing Address
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Address Line | 500 WEST LINCOLN HWY SUITE N
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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 | 219-769-6444
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Fax | 219-755-4790
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Authorized Official
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Title or Position | OFFICE MANAGER PRESIDENT
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Name | MISS MATILDA PEREZ
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Credential |
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Telephone | 219-769-6444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 12009309A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 12008668A
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License Number State | IN
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