# RADCLIFFE FAMILY DENTAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023201175
- **Authorized official:** TRINODA RADCLIFFE DDS (OWNER)
- **Authorized official phone:** (219) 880-1430

## Contact information

- **Practice address:** 1901 GRANT STREET, GARY, IN 46404-2761
- **Practice address phone:** (219) 880-1430
- **Mailing address:** 1901 GRANT STREET, GARY, IN 46404-2761
- **Mailing address phone:** (219) 880-1430
- **Mailing address fax:** (219) 880-1431

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12010399A | IN | Yes |

## Other

- **Enumeration date:** 08/22/2007
- **Last updated:** 07/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200860520 | — | IN |