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2302 S Dixon Rd Ste 125 Kokomo IN 46902-6425 | |
| (765) 453-9389 | |
| (765) 453-9369 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2302 S Dixon Rd Ste 125, Kokomo, Indiana |
| Authorized Official Name and Position | Edward T Mamaril (PRESIDENT) |
| Authorized Official Contact | 7654539389 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2302 S Dixon Rd Ste 125 Kokomo IN 46902-6425 Ph: (765) 453-9389 | 2302 S Dixon Rd Ste 125 Kokomo IN 46902-6425 Ph: (765) 453-9389 |
| NPI Number | 1437238607 |
|---|---|
| Provider Enumeration Date | 11/06/2006 |
| Last Update Date | 10/06/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437238607 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 54001486A (Indiana) | Primary |
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