# THE DENTAL SPECIALISTS INDIANA PC

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

## Provider details

- **NPI number:** 1457081390
- **Authorized official:** JOANNA PROKOP (CFO)
- **Authorized official phone:** (630) 556-2062

## Contact information

- **Practice address:** 10012 CALUMET AVE STE B, MUNSTER, IN 46321-4055
- **Practice address phone:** (630) 556-2062
- **Mailing address:** 17W110 22ND ST STE 150, OAKBROOK TERRACE, IL 60181-4454
- **Mailing address phone:** (630) 556-2062

## Taxonomy

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

## Other

- **Enumeration date:** 06/14/2022
- **Last updated:** 06/14/2022