Organization
DETAILED DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE GUDAS (OWNER)
(219) 374-2400
Entity
Organization
Contact information
Practice address
13963 MORSE ST, CEDAR LAKE, IN 46303-9639
(219) 374-2400
Mailing address
13963 MORSE ST, CEDAR LAKE, IN 46303-9639
(219) 374-2400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12011020
IN
Other
Enumeration date
01/07/2010
Last updated
01/07/2010
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