Organization
ADVANCED DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIE IRMA GAMBETTA (SECRETARY)
(219) 923-3391
Entity
Organization
Contact information
Practice address
15285 W 101ST AVE, SUITE H, DYER, IN 46311-3035
(219) 365-5420
(219) 365-5448
Mailing address
1801 ORIOLE DR, MUNSTER, IN 46321-3443
(219) 923-3391
(219) 365-5448
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010023A
IN
Other
Enumeration date
01/12/2007
Last updated
08/22/2020
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