# ORA NW INDIANA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dental Image
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972119030
- **Authorized official:** DANIEL MCGONIGLE (VP)
- **Authorized official phone:** (708) 906-4236

## Contact information

- **Practice address:** 10705 RANDOLPH ST, CROWN POINT, IN 46307-7615
- **Practice address phone:** (219) 779-9114
- **Mailing address:** 10705 RANDOLPH ST, CROWN POINT, IN 46307-7615

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/23/2020
- **Last updated:** 09/23/2020