Organization
PEDIATRIC DENTAL ASSOCIATES OF INDIANA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL JOSEPH TYREE DDS (OWNER)
(219) 924-4411
Entity
Organization
Contact information
Practice address
2100 45TH ST, HIGHLAND, IN 46322-3742
(219) 924-4411
(219) 924-2314
Mailing address
2100 45TH ST, HIGHLAND, IN 46322-3742
(219) 924-4411
(219) 924-2314
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100208100
—
IN
Enumeration date
10/10/2006
Last updated
09/01/2022
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