Individual
DR. LLYNDALL RHETT FAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MSD
Contact information
Practice address
211 MEDICAL PLZ, MICHIGAN CITY, IN 46360-3364
(219) 879-4559
(219) 879-4559
Mailing address
211 MEDICAL PLZ, MICHIGAN CITY, IN 46360-3364
(219) 879-4559
(219) 879-4559
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12007148A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200365570
—
IN
Enumeration date
07/21/2005
Last updated
09/12/2012
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