Organization
AIRWAY & MIDFACE DEVELOPMENT, LLC
Active
Other names
TMJ AMD
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE ROUSCULP (DIRECTOR OF OPERATIONS)
(574) 968-5166
Entity
Organization
Contact information
Practice address
7221 N FIR RD, GRANGER, IN 46530
(574) 968-5166
(877) 317-3186
Mailing address
7221 N FIR RD, GRANGER, IN 46530
(574) 968-5166
(877) 317-3186
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/04/2023
Last updated
05/04/2023
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