Provider Demographics
NPI: | 1245213867 |
---|---|
Name: | ARGOS FAMILY DENTISTRY PC |
Entity Type: | Organization |
Organization Name: | ARGOS FAMILY DENTISTRY PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | EVAN |
Authorized Official - Last Name: | DIXON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 574-892-5513 |
Mailing Address - Street 1: | 410 N YEARICK ST |
Mailing Address - Street 2: | |
Mailing Address - City: | ARGOS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46501-1036 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 574-892-5513 |
Mailing Address - Fax: | 574-892-5279 |
Practice Address - Street 1: | 410 N YEARICK ST |
Practice Address - Street 2: | |
Practice Address - City: | ARGOS |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46501-1036 |
Practice Address - Country: | US |
Practice Address - Phone: | 574-892-5513 |
Practice Address - Fax: | 574-892-5279 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-11-29 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 12009813 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |