Organization
INDIANA UNIVERSITY NORTHWEST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CINDY ZAK CDA (CLINIC MANAGER)
(219) 980-6772
Entity
Organization
Contact information
Practice address
3400 BROADWAY, GARY, IN 46408-1101
(219) 980-6772
Mailing address
3400 BROADWAY, GARY, IN 46408-1101
(219) 980-6772
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
0
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200082120
—
IN
Enumeration date
12/08/2006
Last updated
07/21/2022
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