MEDICARE: DR. CALEB HAVLIN DDS

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	122300000X	Dentist	12013453A	IN

General Provider Information

NPI Number	:	1174133557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CALEB HAVLIN DDS

Provider Business Mailing Address
First Line	:	2161 HAMSTROM RD
Second Line	:
City	:	PORTAGE
State	:	IN
Zip	:	46368-2294
Country	:	US
Telephone Number	:	219-873-4835
Fax Number	:

Provider Business Practice Location Address
First Line	:	3008 FRANKLIN ST
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-6144
Country	:	US
Telephone Number	:	219-898-4545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2020
Last Update Date	:	07/31/2020

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