# THE DENTAL CENTER OF MISHAWAKA PC

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

## Provider details

- **NPI number:** 1295940518
- **Authorized official:** MRS. REBECCA M NUKES CREDENTIALING MGR (BUSINESS MANAGER)
- **Authorized official phone:** (574) 245-7503

## Contact information

- **Practice address:** 112 IRONWORKS AVE, MISHAWAKA, IN 46544-2057
- **Practice address phone:** (574) 255-4964
- **Mailing address:** 112 IRONWORKS AVE, MISHAWAKA, IN 46544-2057
- **Mailing address phone:** (574) 255-4964

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12008118 | IN | Yes |

## Other

- **Enumeration date:** 05/11/2007
- **Last updated:** 06/11/2013