Organization
SOUTH BEND FAMILY DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRANG KHANH MAI D.D.S. (PRESIDENT)
(574) 233-8444
Entity
Organization
Contact information
Practice address
1637 PORTAGE AVE, SOUTH BEND, IN 46616-1743
(574) 233-8444
(574) 233-8366
Mailing address
1637 PORTAGE AVE, SOUTH BEND, IN 46616-1743
(574) 233-8444
(574) 233-8366
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010453A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200390950A
—
IN
Enumeration date
11/07/2006
Last updated
05/27/2014
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