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General NPI Number Information
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NPI Number | 1982288007
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Entity Type | Organization
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Legal Business Name | MIDWEST FAMILY DENTAL CARE-KOKOMO PC
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 2714 ROCKFORD LN
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City | KOKOMO
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State | IN
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Zip | 46902-3204
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Country | US
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Telephone | 765-453-9040
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Fax | 616-469-1036
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Provider Business Mailing Address
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Address Line | 4025 W MAIN ST STE 102
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City | KALAMAZOO
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State | MI
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Zip | 49006-3726
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Country | US
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Telephone | 269-388-5832
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Fax | 616-469-1036
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JESSICA MARTINEZ
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Credential |
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Telephone | 269-388-5832
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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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