Organization
CEDAR LAKE DENTAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD DOUGLAS KAZWELL D.D.S. (PRESIDENT)
(219) 374-5591
Entity
Organization
Contact information
Practice address
13955 MORSE ST, CEDAR LAKE, IN 46303-9639
(219) 374-5591
(219) 662-2573
Mailing address
13955 MORSE ST, CEDAR LAKE, IN 46303-9639
(219) 374-5591
(219) 662-2573
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
54000250A
IN
Other
Enumeration date
11/01/2006
Last updated
08/22/2020
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