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Organization
MEC DENTAL II, PC
Active
Organization
MEC DENTAL II, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTINA D GRAY (OFFICE MANAGER)
(317) 491-0188
Entity
Organization
Contact information
Practice address
820 E 53RD ST, ANDERSON, IN 46013-1731
(317) 491-0188
Mailing address
13606 CREEKRIDGE LN, MC CORDSVILLE, IN 46055-9599
(317) 491-0188
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010045
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12010045
LICENSE
IN
Enumeration date
10/03/2007
Last updated
10/04/2007
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