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Organization
INDIANA TMJ TREATMENT CENTER
Active
Organization
INDIANA TMJ TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH LAU D.D.S. (DOCTOR)
(765) 778-3332
Entity
Organization
Contact information
Practice address
210 EAST WATER STREET, PENDLETON, IN 46064-0206
(765) 778-3332
(765) 778-4860
Mailing address
210 EAST WATER STREET, P.O. BOX 206, PENDLETON, IN 46064-0206
(765) 778-3332
(765) 778-4860
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7161
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000196290
BLUE CROSS AND BLUE SHIEL
IN
Enumeration date
05/04/2006
Last updated
05/20/2009
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