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501 E Commercial Ave Lowell IN 46356-1816 | |
(219) 696-4940 | |
(219) 696-4800 |
Full Name | |
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Speciality | Dentist |
Location | 501 E Commercial Ave, Lowell, Indiana |
Authorized Official Name and Position | Donald W Pulver (PRESIDENT) |
Authorized Official Contact | 2196964940 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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501 E Commercial Ave Lowell IN 46356-1816 Ph: (219) 696-4940 | 501 E Commercial Ave Lowell IN 46356-1816 Ph: (219) 696-4940 |
NPI Number | 1275983603 |
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Provider Enumeration Date | 06/16/2016 |
Last Update Date | 06/16/2016 |
Identifier | Type | State | Issuer |
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1275983603 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 12008026A (Indiana) | Primary |
122300000X | Dentist | 12012413A (Indiana) | Secondary |