# REO FAMILY DENTAL

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

## Provider details

- **NPI number:** 1417407644
- **Authorized official:** DR. BRITTANY EIRWIN-MAQUEDA DMD (OWNER DENTIST)
- **Authorized official phone:** (812) 649-4416

## Contact information

- **Practice address:** 3430 W STATE ROAD 66, ROCKPORT, IN 47635-9259
- **Practice address phone:** (812) 649-4416
- **Practice address fax:** (812) 649-2651
- **Mailing address:** 3430 W STATE ROAD 66, ROCKPORT, IN 47635-9259
- **Mailing address phone:** (812) 649-4416
- **Mailing address fax:** (812) 649-2651

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12011855A | IN | Yes |

## Other

- **Enumeration date:** 10/12/2016
- **Last updated:** 10/13/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 201115460 | — | IN |