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General NPI Number Information
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NPI Number | 1669569893
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Entity Type | Organization
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Legal Business Name | PKR ENDODONTICS, P.C.
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8809 W 400 N
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-9330
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Country | US
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Telephone | 219-879-2300
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Fax | 219-879-6420
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Provider Business Mailing Address
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Address Line | 8809 W 400 N
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-9330
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Country | US
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Telephone | 219-879-2300
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Fax | 219-879-6420
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILIP KARL RADTKE
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Credential | D.D.S.
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Telephone | 219-879-2300
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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 | 12009839A
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License Number State | IN
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