# FREMONT FAMILY DENTISTRY, P.C.

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

## Provider details

- **NPI number:** 1871715359
- **Authorized official:** MRS. SUSAN H. MAUK D.D.S (PRESIDENT)
- **Authorized official phone:** (260) 495-2255

## Contact information

- **Practice address:** 1003 W TOLEDO STREET, FREMONT, IN 46737-0667
- **Practice address phone:** (260) 495-2255
- **Practice address fax:** (260) 495-9023
- **Mailing address:** P.O. BOX 667, FREMONT, IN 46737-0667
- **Mailing address phone:** (260) 495-2255
- **Mailing address fax:** (260) 495-9023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 012537445 001 7 | IN | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 05/17/2016