# AFFILIATED FAMILY DENTISTS PC

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

## Provider details

- **NPI number:** 1760527592
- **Authorized official:** MS. CHARYL KRIVAK (TREATMENT COORDINATOR)
- **Authorized official phone:** (574) 277-2220

## Contact information

- **Practice address:** 605 W DOUGLAS ROAD, MISHAWAKA, IN 46545
- **Practice address phone:** (574) 277-2220
- **Practice address fax:** (574) 277-8108
- **Mailing address:** 605 W DOUGLAS ROAD, MISHAWAKA, IN 46545
- **Mailing address phone:** (574) 277-2220
- **Mailing address fax:** (574) 277-8108

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 02/20/2007
- **Last updated:** 01/24/2011