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Organization

PERIODONTAL ASSOCIATES OF SOUTH BEND

Active
Other names
Periodontal Associates of South Bend
Organization subpart
No

Provider details

NPI number
Authorized official
GLORIA ROYER (PRACTICE MANAGER)
(765) 447-9319
Entity
Organization

Contact information

Practice address
1918 EDISON RD, SOUTH BEND, IN 46617-1711
(574) 287-8900
Mailing address
1918 EDISON RD, SOUTH BEND, IN 46617-1711
(574) 287-8900

Taxonomy

Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12013130A
DENTAL LICENSE
IN
Enumeration date
06/02/2021
Last updated
06/02/2021
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