Provider Demographics
NPI:1497147086
Name:EASTMAN DENTAL
Entity Type:Organization
Organization Name:EASTMAN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-2092
Mailing Address - Street 1:9335 CALUMET AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4175
Mailing Address - Country:US
Mailing Address - Phone:219-836-2092
Mailing Address - Fax:219-836-9501
Practice Address - Street 1:9335 CALUMET AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4175
Practice Address - Country:US
Practice Address - Phone:219-836-2092
Practice Address - Fax:219-836-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011539A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty