# PLYMOUTH 20/20 DENTAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 20/20 DENTAL, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1689122491
- **Legal business name:** 20/20 DENTAL, LLC
- **Authorized official:** DR. RONALD I PROKES DDS (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (317) 601-6010

## Contact information

- **Practice address:** 1409 N MICHIGAN ST, PLYMOUTH, IN 46563-1119
- **Practice address phone:** (574) 936-8787
- **Mailing address:** 1409 N MICHIGAN ST, PLYMOUTH, IN 46563-1119
- **Mailing address phone:** (574) 936-8787

## Taxonomy

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

## Other

- **Enumeration date:** 09/21/2016
- **Last updated:** 09/21/2016