| Pediatric Dental Associates Of Indiana, Inc | |
|
2100 45th St Highland IN 46322-3742 | |
| (219) 924-4411 | |
| (219) 924-2314 |
| Full Name | Pediatric Dental Associates Of Indiana, Inc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2100 45th St, Highland, Indiana |
| Authorized Official Name and Position | Carl Joseph Tyree (OWNER) |
| Authorized Official Contact | 2199244411 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dental Associates Of Indiana, Inc 2100 45th St Highland IN 46322-3742 Ph: (219) 924-4411 | Pediatric Dental Associates Of Indiana, Inc 2100 45th St Highland IN 46322-3742 Ph: (219) 924-4411 |
| NPI Number | 1679661565 |
|---|---|
| Provider Enumeration Date | 10/10/2006 |
| Last Update Date | 09/01/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679661565 | NPI | - | NPPES |
| 100208100 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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