Organization
THE MUNCIE DENTAL PLACE L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERESA MICHELLE WATKINS D.D.S. (OWNER)
(765) 282-5655
Entity
Organization
Contact information
Practice address
1804 W MCGALLIARD RD, MUNCIE, IN 47304-2209
(765) 282-5655
(765) 587-0103
Mailing address
1804 W MCGALLIARD RD, MUNCIE, IN 47304-2209
(765) 282-5655
(765) 587-0103
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010271A
IN
1223G0001X
General Practice Dentistry
12011056A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200888510
—
IN
05
—
200962440
—
IN
Enumeration date
11/17/2011
Last updated
11/17/2011
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