Organization
GRANGER DENTAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH E HICKEY III DDS (DENTIST OWNER)
(574) 274-7778
Entity
Organization
Contact information
Practice address
6910 N MAIN ST, BLDG 1, UNIT 58, GRANGER, IN 46530-9680
(574) 277-4235
Mailing address
6910 N MAIN ST, BLDG 1, UNIT 58, GRANGER, IN 46530-9680
(574) 277-4235
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011040A
IN
Other
Enumeration date
06/01/2016
Last updated
06/01/2016
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