Organization
WABASH DENTAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY ANNE BAIN DDS (OWNER)
(260) 563-4065
Entity
Organization
Contact information
Practice address
278 MANCHESTER AVE, WABASH, IN 46992-1808
(260) 563-4065
(260) 563-4193
Mailing address
278 MANCHESTER AVE, WABASH, IN 46992-1808
(260) 563-4065
(260) 563-4193
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
IN12007971
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1223G0001X
—
IN
Enumeration date
07/07/2009
Last updated
07/07/2009
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