Mishawaka Dental LLC

NPI #1730624529 in Mishawaka, Indiana

Provider Information

NPI Number: 1730624529
Entity Type: Organization
Organization Name: Mishawaka Dental LLC
Primary Specialty: Dentist
Enumeration Date: Jan 3, 2017
Last Updated: Jan 3, 2017

Practice Location

Address: 4170 GRAPE RD
City: Mishawaka
State: Indiana
ZIP Code: 46545-2610
Phone: (574) 272-4200

Authorized Official

Name: HEATHER KRAUSHAAR
Title: PSR
Phone: (315) 454-6000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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