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General NPI Number Information
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NPI Number | 1982112116
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Entity Type | Organization
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Legal Business Name | THE DENTISTS AT GATEWAY CROSSING LLC
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 6621 W BROADWAY STE 600
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City | MCCORDSVILLE
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State | IN
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Zip | 46055-8811
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Country | US
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Telephone | 317-589-0495
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Fax |
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Provider Business Mailing Address
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Address Line | 1615 N COLLEGE AVE APT 1
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1748
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Country | US
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Telephone | 724-272-8228
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW VOGT
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Credential | DDS
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Telephone | 724-272-8228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12012701A
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License Number State | IN
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