# PRO DENTAL IN 1 PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Destiny Dental of Hammond
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316774698
- **Authorized official:** SIMONE WILSON-ADELEKE MPA-PPA (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (732) 731-8398

## Contact information

- **Practice address:** 1738 165TH ST, HAMMOND, IN 46320-2814
- **Practice address phone:** (219) 844-8000
- **Practice address fax:** (219) 844-8008
- **Mailing address:** 10 WOODBRIDGE CENTER DR STE 520, WOODBRIDGE, NJ 07095-1152
- **Mailing address phone:** (732) 731-8398

## Taxonomy

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

## Other

- **Enumeration date:** 09/19/2024
- **Last updated:** 09/19/2024