# INDIANA DENTAL ASSOCIATES

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

## Provider details

- **NPI number:** 1548037278
- **Authorized official:** LUCIA GAMINO (GENERAL MANAGER)
- **Authorized official phone:** (773) 530-7550

## Contact information

- **Practice address:** 1901 GRANT ST, GARY, IN 46404-2761
- **Practice address phone:** (219) 880-1430
- **Practice address fax:** (219) 239-2197
- **Mailing address:** 1600 E 93RD ST, CHICAGO, IL 60617-3607
- **Mailing address phone:** (773) 530-7550
- **Mailing address fax:** (773) 530-0287

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/04/2023
- **Last updated:** 12/04/2023