# MICHIANA FAMILY DENTAL LLC

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

## Provider details

- **NPI number:** 1467946467
- **Authorized official:** DR. SRINIVAS R DURSHANAPALLI DDS (OWNER)
- **Authorized official phone:** (203) 215-4687

## Contact information

- **Practice address:** 3575 PORTAGE AVE, SOUTH BEND, IN 46628-6092
- **Practice address phone:** (203) 215-4687
- **Mailing address:** 3575 PORTAGE AVE, SOUTH BEND, IN 46628-6092

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 06/22/2018
- **Last updated:** 09/17/2020