Organization
BITTERSWEET RD. FAMILY DENTIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK D. SHAFER DDS (OWNER)
(574) 277-7995
Entity
Organization
Contact information
Practice address
51410 BITTERSWEET RD, GRANGER, IN 46530-9119
(574) 277-7995
(574) 277-0184
Mailing address
51410 BITTERSWEET RD, GRANGER, IN 46530-9119
(574) 277-7995
(574) 277-0184
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009526
IN
Other
Enumeration date
03/01/2007
Last updated
08/22/2020
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