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Granger Dental Group, LLC

Dentist, General Practice in Granger, IN. Organization (NPI-2).

NPI number1245688282
StatusActive
Last updated in NPPESJun 1, 2016

Details

NPI
1245688282
Entity type
Organization (NPI-2)
Legal business name
Granger Dental Group, LLC
Organization subpart
No
Enumeration date
Jun 1, 2016
Last updated
Jun 1, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice12011040AINYes

Practice location

6910 N Main St
Bldg 1, Unit 58
Granger, IN 46530-9680

Phone 574-277-4235

Mailing address

6910 N Main St
Bldg 1, Unit 58
Granger, IN 46530-9680

Phone 574-277-4235

Authorized official

Joseph E Hickey
Dentist Owner
5742747778

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