Organization
GREAT LAKES FAMILY DENTAL GROUP-MUNCIE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA J. HART (CORPORATE MANAGER)
(810) 625-2860
Entity
Organization
Contact information
Practice address
1003 W. MCGALLIARD ROAD, MUNCIE, IN 47303
(765) 288-1307
Mailing address
1003 W. MCGALLIARD ROAD, MUNCIE, IN 47303
(765) 288-1307
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12012248A
IN
Other
Enumeration date
12/09/2014
Last updated
12/09/2014
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