Organization
L. RHETT FAGG, D.D.S., M.S.D., PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CYNTHIA A BECHINSKI (STAFF ASSISTANT)
(219) 879-4559
Entity
Organization
Contact information
Practice address
211 MEDICAL PLZ, MICHIGAN CITY, IN 46360-3364
(219) 879-4559
(219) 879-4559
Mailing address
211 MEDICAL PLZ, MICHIGAN CITY, IN 46360-3364
(219) 879-4559
(219) 879-4559
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12007148A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200356670A
—
IN
Enumeration date
04/03/2008
Last updated
09/24/2012
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