# GRANGER DENTAL GROUP, LLC

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

## Provider details

- **NPI number:** 1245688282
- **Authorized official:** DR. JOSEPH E HICKEY III DDS (DENTIST OWNER)
- **Authorized official phone:** (574) 274-7778

## Contact information

- **Practice address:** 6910 N MAIN ST, BLDG 1, UNIT 58, GRANGER, IN 46530-9680
- **Practice address phone:** (574) 277-4235
- **Mailing address:** 6910 N MAIN ST, BLDG 1, UNIT 58, GRANGER, IN 46530-9680
- **Mailing address phone:** (574) 277-4235

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12011040A | IN | Yes |

## Other

- **Enumeration date:** 06/01/2016
- **Last updated:** 06/01/2016