Organization
INDIANA DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCIA GAMINO (GENERAL MANAGER)
(773) 530-7550
Entity
Organization
Contact information
Practice address
1901 GRANT ST, GARY, IN 46404-2761
(219) 880-1430
(219) 239-2197
Mailing address
1600 E 93RD ST, CHICAGO, IL 60617-3607
(773) 530-7550
(773) 530-0287
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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