Provider Demographics
NPI:1497910574
Name:ADVANCED DENTAL CARE (CROWN POINT) P.C.
Entity Type:Organization
Organization Name:ADVANCED DENTAL CARE (CROWN POINT) P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-726-1611
Mailing Address - Street 1:11055 BROADWAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9177
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11055 BROADWAY
Practice Address - Street 2:SUITE E
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-9177
Practice Address - Country:US
Practice Address - Phone:219-306-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty