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Organization
SOUTH BEND FAMILY DENTISTRY, P.C.
Active
Organization
SOUTH BEND FAMILY DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRANG KHANH MAI D.D.S. (PRESIDENT)
(574) 233-8444
Entity
Organization
Contact information
Practice address
1637 PORTAGE AVE, SOUTH BEND, IN 46616-1743
(574) 233-8444
(574) 233-8366
Mailing address
1637 PORTAGE AVE, SOUTH BEND, IN 46616-1743
(574) 233-8444
(574) 233-8366
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010453A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200390950A
—
IN
Enumeration date
11/07/2006
Last updated
05/27/2014
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