Organization
J MATTHEW CRONKHITE DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTI STICHTER (OFFICE MANAGER)
(765) 471-6025
Entity
Organization
Contact information
Practice address
3667 BRADDOCK DR STE B, LAFAYETTE, IN 47909-7302
(765) 471-6025
Mailing address
3667 BRADDOCK DR STE B, LAFAYETTE, IN 47909-7302
(765) 471-6025
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12010734A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200860550
—
IN
Enumeration date
06/05/2015
Last updated
06/05/2015
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