| Peru Dental Care | |
|
5 Logan St Peru IN 46970-1642 | |
| (765) 473-9336 | |
| (765) 460-5743 |
| Full Name | Peru Dental Care |
|---|---|
| Speciality | Dentist |
| Location | 5 Logan St, Peru, Indiana |
| Authorized Official Name and Position | Justin D Brown (OWNER) |
| Authorized Official Contact | 7654739336 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Peru Dental Care 5 Logan St Peru IN 46970-1642 Ph: (765) 473-9336 | Peru Dental Care 5 Logan St Peru IN 46970-1642 Ph: (765) 473-9336 |
| NPI Number | 1851573539 |
|---|---|
| Provider Enumeration Date | 12/04/2007 |
| Last Update Date | 07/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851573539 | NPI | - | NPPES |
| 200864790A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 10988 (Indiana) | Primary |
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