Provider Demographics
NPI:1326439787
Name:TMJ & SLEEP THERAPY CENTRE OF NORTHERN INDIANA
Entity Type:Organization
Organization Name:TMJ & SLEEP THERAPY CENTRE OF NORTHERN INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:KLAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-968-5166
Mailing Address - Street 1:17901 TURNERS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1529
Mailing Address - Country:US
Mailing Address - Phone:574-968-5166
Mailing Address - Fax:574-277-5217
Practice Address - Street 1:17901 TURNERS DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1529
Practice Address - Country:US
Practice Address - Phone:574-968-5166
Practice Address - Fax:574-277-5217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011496A122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty