Organization
SOMETHING COOL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA ROYER (PRACTICE MANAGER)
(765) 447-9319
Entity
Organization
Contact information
Practice address
415 N 26TH ST STE 303, LAFAYETTE, IN 47904-2893
(765) 447-9319
Mailing address
415 N 26TH ST STE 303, LAFAYETTE, IN 47904-2893
(765) 447-9319
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12013130A
STATE DENTAL LICENSE
IN
Enumeration date
06/02/2021
Last updated
06/02/2021
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