Organization
THE DENTAL CENTER OF MISHAWAKA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBECCA M NUKES CREDENTIALING MGR (BUSINESS MANAGER)
(574) 245-7503
Entity
Organization
Contact information
Practice address
112 IRONWORKS AVE, MISHAWAKA, IN 46544-2057
(574) 255-4964
Mailing address
112 IRONWORKS AVE, MISHAWAKA, IN 46544-2057
(574) 255-4964
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008118
IN
Other
Enumeration date
05/11/2007
Last updated
06/11/2013
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