Organization
JACK E. GORIS D.D.S.,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK E. GORIS D.D.S. (PRESIDENT)
(574) 753-4542
Entity
Organization
Contact information
Practice address
1821 CHASE RD, LOGANSPORT, IN 46947-1200
(574) 753-4542
(574) 722-5059
Mailing address
1821 CHASE RD, LOGANSPORT, IN 46947-1200
(574) 753-4542
(574) 722-5059
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008389
IN
Other
Enumeration date
02/19/2007
Last updated
08/22/2020
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