Organization
TAMARA EATON DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDACE WILDE (PRACTICE ADMINISTRATOR)
(219) 210-3495
Entity
Organization
Contact information
Practice address
1213 E COOLSPRING AVE, MICHIGAN CITY, IN 46360-6319
(219) 872-9151
(219) 873-3341
Mailing address
1213 E COOLSPRING AVE, MICHIGAN CITY, IN 46360-6319
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009857A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200384300A
—
IN
Enumeration date
12/11/2015
Last updated
12/11/2015
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