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Organization
SHAKAMAK FAMILY DENTISTRY, LLC
Active
Organization
SHAKAMAK FAMILY DENTISTRY, LLC
Active
Other names
Shakamak Family Dentistry, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN W KELLETT DDS (OWNER)
(812) 665-2275
Entity
Organization
Contact information
Practice address
206 S MERIDIAN ST, JASONVILLE, IN 47438-1520
(812) 665-2275
(812) 665-9374
Mailing address
190 C ST NW, LINTON, IN 47441-1328
(812) 847-8646
(812) 847-8761
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12012106A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201234800A
—
IN
Enumeration date
06/18/2017
Last updated
06/18/2017
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