# GRANGER FAMILY DENTISTRY, PC

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

## Provider details

- **NPI number:** 1619072147
- **Authorized official:** MR. THOMAS JOHN ANGLEMIRE D.D.S. (OWNER / PRESIDENT)
- **Authorized official phone:** (574) 277-5406

## Contact information

- **Practice address:** 12545 ADAMS RD, GRANGER, IN 46530-9226
- **Practice address phone:** (574) 277-5406
- **Practice address fax:** (574) 277-5467
- **Mailing address:** 12545 ADAMS RD, GRANGER, IN 46530-9226
- **Mailing address phone:** (574) 277-5406
- **Mailing address fax:** (574) 277-5467

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12007958B | IN | Yes |
| 1223G0001X | General Practice Dentistry | 12009209B | IN | — |

## Other

- **Enumeration date:** 09/13/2006
- **Last updated:** 09/14/2020