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Organization
THE MUNCIE DENTAL PLACE L.L.C.
Active
Organization
THE MUNCIE DENTAL PLACE L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERESA MICHELLE WATKINS D.D.S. (OWNER)
(765) 282-5655
Entity
Organization
Contact information
Practice address
1804 W MCGALLIARD RD, MUNCIE, IN 47304-2209
(765) 282-5655
(765) 587-0103
Mailing address
1804 W MCGALLIARD RD, MUNCIE, IN 47304-2209
(765) 282-5655
(765) 587-0103
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010271A
IN
1223G0001X
General Practice Dentistry
12011056A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200888510
—
IN
05
—
200962440
—
IN
Enumeration date
11/17/2011
Last updated
11/17/2011
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