# NEW HAVEN DENTAL GROUP

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

## Provider details

- **NPI number:** 1861841652
- **Authorized official:** AMANDA RUTHERFORD (OFFICE MANAGER)
- **Authorized official phone:** (260) 432-8596

## Contact information

- **Practice address:** 615 PROFESSIONAL PARK DR, NEW HAVEN, IN 46774-1850
- **Practice address phone:** (260) 493-2113
- **Mailing address:** 615 PROFESSIONAL PARK DR, NEW HAVEN, IN 46774-1850
- **Mailing address phone:** (260) 493-2113

## Taxonomy

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

## Other

- **Enumeration date:** 06/13/2016
- **Last updated:** 06/13/2016