Organization
HOOSIER DENTIST LLC
Active
Other names
Wellness Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL DHAENENS (MANAGING MEMBER)
(574) 309-5860
Entity
Organization
Contact information
Practice address
2900 W RAY RD, STE 3, CHANDLER, AZ 85224
(574) 309-5860
Mailing address
2900 W RAY RD, STE 3, CHANDLER, AZ 85224
(574) 309-5860
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
161222
AZ
Other
Enumeration date
12/14/2015
Last updated
12/14/2015
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