Organization
PLYMOUTH 20/20 DENTAL, LLC
Active
Parent organization
20/20 DENTAL, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
20/20 DENTAL, LLC
Authorized official
DR. RONALD I PROKES DDS (CHIEF FINANCIAL OFFICER)
(317) 601-6010
Entity
Organization
Contact information
Practice address
1409 N MICHIGAN ST, PLYMOUTH, IN 46563-1119
(574) 936-8787
Mailing address
1409 N MICHIGAN ST, PLYMOUTH, IN 46563-1119
(574) 936-8787
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
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