Provider Demographics
NPI:1477192136
Name:MERRILLVILLE DENTAL CENTER INC.
Entity Type:Organization
Organization Name:MERRILLVILLE DENTAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:219-333-6166
Mailing Address - Street 1:303 W 89TH AVE STE E2
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6295
Mailing Address - Country:US
Mailing Address - Phone:219-755-0045
Mailing Address - Fax:
Practice Address - Street 1:303 W 89TH AVE STE E2
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6295
Practice Address - Country:US
Practice Address - Phone:219-755-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental