# MINI DENTAL IMPLANT CENTERS OF AMERICA LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** YORKTOWN FAMILY DENTISTRY INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1699033944
- **Legal business name:** YORKTOWN FAMILY DENTISTRY INC
- **Authorized official:** STEPHEN J GANT DDS (DENTIST)
- **Authorized official phone:** (765) 759-8351

## Contact information

- **Practice address:** 2001 S TIGER DRIVE, YORKTOWN, IN 47396
- **Practice address phone:** (765) 759-8351
- **Practice address fax:** (765) 759-8749
- **Mailing address:** 2001 S TIGER DRIVE, YORKTOWN, IN 47396
- **Mailing address phone:** (765) 759-8351
- **Mailing address fax:** (765) 759-8749

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12007237 | IN | Yes |

## Other

- **Enumeration date:** 04/24/2012
- **Last updated:** 04/24/2012