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Organization
PERIODONTAL ASSOCIATES OF SOUTH BEND
Active
Organization
PERIODONTAL ASSOCIATES OF SOUTH BEND
Active
Other names
Periodontal Associates of South Bend
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA ROYER (PRACTICE MANAGER)
(765) 447-9319
Entity
Organization
Contact information
Practice address
1918 EDISON RD, SOUTH BEND, IN 46617-1711
(574) 287-8900
Mailing address
1918 EDISON RD, SOUTH BEND, IN 46617-1711
(574) 287-8900
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12013130A
DENTAL LICENSE
IN
Enumeration date
06/02/2021
Last updated
06/02/2021
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