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General NPI Number Information
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NPI Number | 1790504041
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Entity Type | Organization
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Legal Business Name | KENDALLVILLE FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 1843 IDA RED RD
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City | KENDALLVILLE
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State | IN
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Zip | 46755-2873
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Country | US
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Telephone | 260-343-0568
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Fax |
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Provider Business Mailing Address
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Address Line | 111 EAGLE CLIFF CV
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City | HUNTERTOWN
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State | IN
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Zip | 46748-9288
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Country | US
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Telephone | 248-425-8825
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID M GRIFFITH
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Credential | DDS
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Telephone | 248-425-8825
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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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