| Jackson Creek Dental | |
|
1124 S College Mall Rd Bloomington IN 47401-6178 | |
| (812) 336-5525 | |
| (812) 322-5520 |
| Full Name | Jackson Creek Dental |
|---|---|
| Speciality | Dentist |
| Location | 1124 S College Mall Rd, Bloomington, Indiana |
| Authorized Official Name and Position | Ryan D Tschetter (DENTIST) |
| Authorized Official Contact | 8123365525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Creek Dental 1124 S College Mall Rd Bloomington IN 47401-6178 Ph: (812) 336-5525 | Jackson Creek Dental 1124 S College Mall Rd Bloomington IN 47401-6178 Ph: (812) 336-5525 |
| NPI Number | 1114362803 |
|---|---|
| Provider Enumeration Date | 05/08/2013 |
| Last Update Date | 05/08/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114362803 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12010765A (Indiana) | Primary |
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