Jackson Creek Dental | |
1124 S College Mall Rd Bloomington IN 47401 | |
(812) 336-5525 | |
(812) 332-5520 |
Full Name | Jackson Creek Dental |
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Speciality | Dentist - General Practice |
Location | 1124 S College Mall Rd, Bloomington, Indiana |
Authorized Official Name and Position | Ryan David Tschettei (OWNER) |
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 Ph: (812) 336-5525 | Jackson Creek Dental 1124 S College Mall Rd Bloomington IN 47401 Ph: (812) 336-5525 |
NPI Number | 1295062339 |
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Provider Enumeration Date | 11/11/2009 |
Last Update Date | 05/17/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295062339 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 12010765 (Indiana) | Primary |
1223G0001X | Dentist - General Practice | 12010729 (Indiana) | Secondary |
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