# GOSHEN FAMILY & COSMETIC DENTISTRY, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Goshen Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770790149
- **Authorized official:** DR. MARK DEAL DDS (PRESIDENT)
- **Authorized official phone:** (574) 534-5528

## Contact information

- **Practice address:** 1625 SUNNYFIELD DR, GOSHEN, IN 46526-9264
- **Practice address phone:** (574) 534-5582
- **Practice address fax:** (574) 534-8146
- **Mailing address:** 1625 SUNNYFIELD DR, GOSHEN, IN 46526-9264
- **Mailing address phone:** (574) 534-5582
- **Mailing address fax:** (574) 534-8146

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12010108 | IN | Yes |
| 1223G0001X | General Practice Dentistry | 12010143 | IN | — |

## Other

- **Enumeration date:** 05/16/2007
- **Last updated:** 08/22/2020