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Organization
REO FAMILY DENTAL
Active
Organization
REO FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRITTANY EIRWIN-MAQUEDA DMD (OWNER DENTIST)
(812) 649-4416
Entity
Organization
Contact information
Practice address
3430 W STATE ROAD 66, ROCKPORT, IN 47635-9259
(812) 649-4416
(812) 649-2651
Mailing address
3430 W STATE ROAD 66, ROCKPORT, IN 47635-9259
(812) 649-4416
(812) 649-2651
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011855A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201115460
—
IN
Enumeration date
10/12/2016
Last updated
10/13/2016
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