Shakamak Family Dentistry, Llc | |
206 S Meridian St Jasonville IN 47438-1520 | |
(812) 665-2275 | |
(812) 665-9374 |
Full Name | Shakamak Family Dentistry, Llc |
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Speciality | Dentist - General Practice |
Location | 206 S Meridian St, Jasonville, Indiana |
Authorized Official Name and Position | Steven W Kellett (OWNER) |
Authorized Official Contact | 8126652275 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Shakamak Family Dentistry, Llc 190 C St Nw Linton IN 47441-1328 Ph: (812) 847-8646 | Shakamak Family Dentistry, Llc 206 S Meridian St Jasonville IN 47438-1520 Ph: (812) 665-2275 |
NPI Number | 1568992022 |
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Provider Enumeration Date | 06/18/2017 |
Last Update Date | 06/18/2017 |
Identifier | Type | State | Issuer |
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1568992022 | NPI | - | NPPES |
201234800A | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | 12012106A (Indiana) | Primary |