| Plymouth 20/20 Dental, Llc | |
|
1409 N Michigan St Plymouth IN 46563-1119 | |
| (574) 936-8787 | |
| Not Available |
| Full Name | Plymouth 20/20 Dental, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1409 N Michigan St, Plymouth, Indiana |
| Authorized Official Name and Position | Ronald I Prokes (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3176016010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Plymouth 20/20 Dental, Llc 1409 N Michigan St Plymouth IN 46563-1119 Ph: (574) 936-8787 | Plymouth 20/20 Dental, Llc 1409 N Michigan St Plymouth IN 46563-1119 Ph: (574) 936-8787 |
| NPI Number | 1689122491 |
|---|---|
| Provider Enumeration Date | 09/21/2016 |
| Last Update Date | 09/21/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689122491 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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