MEDICARE: AFFORDABLE DENTAL CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1134566938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTAL CARE

Provider Business Mailing Address
First Line	:	2625 45TH ST
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2902
Country	:	US
Telephone Number	:	219-595-8989
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 45TH ST
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2902
Country	:	US
Telephone Number	:	219-595-8989
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ANIL PAL
Credential	:
Telephone Number	:	312-848-4141

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	06/03/2013

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Directions to “AFFORDABLE DENTAL CARE ” Practice Location

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