Organization
ADOLESCENT & PEDIACTRIC DENTISTRY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL RICHARD MUSAL D.D.S. (OWNER)
(765) 288-5527
Entity
Organization
Contact information
Practice address
610 S TILLOTSON AVE STE 205, MUNCIE, IN 47304-4450
(765) 288-5527
(765) 288-6119
Mailing address
610 S TILLOTSON AVE STE 205, MUNCIE, IN 47304-4450
(765) 288-5527
(765) 288-6119
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12010472A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200408960A
—
IN
Enumeration date
05/27/2008
Last updated
05/27/2008
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