# INDIJU 5 DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Susghuena Dental Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346859402
- **Authorized official:** DR. BARRY ALLYN MOSS DMD (PRESIDENT)
- **Authorized official phone:** (717) 991-8750

## Contact information

- **Practice address:** 100 S 18TH ST, COLUMBIA, PA 17512-9596
- **Practice address phone:** (717) 991-8750
- **Practice address fax:** (717) 647-2106
- **Mailing address:** 245 DUNHAM DR, HUMMELSTOWN, PA 17036-8040
- **Mailing address phone:** (717) 991-8750
- **Mailing address fax:** (717) 647-2106

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/24/2020
- **Last updated:** 07/24/2020