Organization
JACKSON CREEK DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN DAVID TSCHETTEI DDS (OWNER)
(812) 336-5525
Entity
Organization
Contact information
Practice address
1124 S COLLEGE MALL RD, BLOOMINGTON, IN 47401
(812) 336-5525
(812) 332-5520
Mailing address
1124 S COLLEGE MALL RD, BLOOMINGTON, IN 47401
(812) 336-5525
(812) 332-5520
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12010729
IN
1223G0001X
General Practice Dentistry
Primary
12010765
IN
Other
Enumeration date
11/11/2009
Last updated
05/17/2018
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