| Bittersweet Rd. Family Dentist | |
|
51410 Bittersweet Rd Granger IN 46530-9119 | |
| (574) 277-7995 | |
| (574) 277-0184 |
| Full Name | Bittersweet Rd. Family Dentist |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 51410 Bittersweet Rd, Granger, Indiana |
| Authorized Official Name and Position | Mark D. Shafer (OWNER) |
| Authorized Official Contact | 5742777995 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bittersweet Rd. Family Dentist 51410 Bittersweet Rd Granger IN 46530-9119 Ph: (574) 277-7995 | Bittersweet Rd. Family Dentist 51410 Bittersweet Rd Granger IN 46530-9119 Ph: (574) 277-7995 |
| NPI Number | 1942338231 |
|---|---|
| Provider Enumeration Date | 03/01/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942338231 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 12009526 (Indiana) | Primary |
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