Provider Demographics
NPI:1013216423
Name:THE CENTER FOR IMPLANTS, SEDATION AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:THE CENTER FOR IMPLANTS, SEDATION AND COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-322-3171
Mailing Address - Street 1:890 RICHARD RD
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1779
Mailing Address - Country:US
Mailing Address - Phone:219-322-3171
Mailing Address - Fax:219-322-9986
Practice Address - Street 1:890 RICHARD RD
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1779
Practice Address - Country:US
Practice Address - Phone:219-322-3171
Practice Address - Fax:219-322-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty