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General NPI Number Information
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NPI Number | 1962816777
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Entity Type | Organization
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Legal Business Name | DENTAL ARTS GROUP, LLC
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 850 MARSH ST SUITE A
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City | VALPARAISO
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State | IN
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Zip | 46385-6239
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Country | US
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Telephone | 219-464-8532
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Fax | 219-548-8842
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Provider Business Mailing Address
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Address Line | 850 MARSH ST SUITE A
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City | VALPARAISO
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State | IN
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Zip | 46385-6239
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Country | US
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Telephone | 219-464-8532
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Fax | 219-548-8842
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MICHAEL J UZELAC
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Credential | DDS
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Telephone | 219-464-8532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12008155A
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License Number State | IN
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