Organization
RADCLIFFE FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRINODA RADCLIFFE DDS (OWNER)
(219) 880-1430
Entity
Organization
Contact information
Practice address
1901 GRANT STREET, GARY, IN 46404-2761
(219) 880-1430
Mailing address
1901 GRANT STREET, GARY, IN 46404-2761
(219) 880-1430
(219) 880-1431
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010399A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200860520
—
IN
Enumeration date
08/22/2007
Last updated
07/25/2008
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