Provider Demographics
NPI:1497869341
Name:CHILDRENS DENTAL CENTER OF NORTHWEST INDIANA INC
Entity Type:Organization
Organization Name:CHILDRENS DENTAL CENTER OF NORTHWEST INDIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:RIGG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-769-6636
Mailing Address - Street 1:7863 BROADWAY
Mailing Address - Street 2:SUITE #111
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5553
Mailing Address - Country:US
Mailing Address - Phone:219-769-6636
Mailing Address - Fax:219-769-4396
Practice Address - Street 1:7863 BROADWAY
Practice Address - Street 2:SUITE #111
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5553
Practice Address - Country:US
Practice Address - Phone:219-769-6636
Practice Address - Fax:219-769-4396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty