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General NPI Number Information
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NPI Number | 1861417818
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF NORTHWEST INDIANA PC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2833 LINCOLN ST SUITE 1
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City | HIGHLAND
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State | IN
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Zip | 46322-1924
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Country | US
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Telephone | 219-838-2007
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Fax | 219-972-5267
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Provider Business Mailing Address
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Address Line | 2833 LINCOLN ST SUITE 1
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City | HIGHLAND
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State | IN
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Zip | 46322-1924
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Country | US
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Telephone | 219-838-2007
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Fax | 219-972-5267
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERRY G. SCHECHNER
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Credential | D.D.S.
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Telephone | 219-838-2007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12008141A
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License Number State | IN
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