Organization
EDGEWOOD DENTAL, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALERIE HAUGHTINGTON DDS (PARTNER/DENTIST)
(219) 872-2110
Entity
Organization
Contact information
Practice address
3008 FRANKLIN ST, MICHIGAN CITY, IN 46360-4636
(219) 872-2110
(219) 872-1082
Mailing address
3008 FRANKLIN ST, MICHIGAN CITY, IN 46360
(219) 872-2110
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009354
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100376490B
—
IN
01
—
1053411645
PROVIDER NPI
IN
01
—
1245390236
PROVIDER NPI
IN
Enumeration date
08/01/2017
Last updated
08/01/2017
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