Organization
MISHAWAKA DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER KRAUSHAAR (PSR)
(315) 454-6000
Entity
Organization
Contact information
Practice address
4170 GRAPE RD, MISHAWAKA, IN 46545-2610
(574) 272-4200
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12012619A
IN
Other
Enumeration date
01/03/2017
Last updated
01/03/2017
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