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2705 S Berkley Building 2 Suite B Kokomo IN 46902 | |
| (765) 453-2267 | |
| (765) 453-1150 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2705 S Berkley, Kokomo, Indiana |
| Authorized Official Name and Position | Matthew D Pate (CORPORATION PRESIDENT/CO -OWNER) |
| Authorized Official Contact | 7654532267 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2705 S Berkley Building 2 Suite B Kokomo IN 46902 Ph: (765) 453-2267 | 2705 S Berkley Building 2 Suite B Kokomo IN 46902 Ph: (765) 453-2267 |
| NPI Number | 1669582813 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669582813 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
Kokomo Pediatric Dentistry, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2350 S Dixon Rd Ste 425, Kokomo, IN 46902 Phone: 765-453-6000 | |
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Family And Cosmetic Dentistry Of Kokomo, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5111 Clinton Dr, Kokomo, IN 46902 Phone: 765-453-4369 |