Provider Demographics
NPI:1497954622
Name:HEARTLAND DENTAL CARE OF INDIANA, PC
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF INDIANA, PC
Other - Org Name:KOKOMO ORAL IMPLANTOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:315 W LINCOLN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3850
Mailing Address - Country:US
Mailing Address - Phone:765-453-7692
Mailing Address - Fax:765-453-7694
Practice Address - Street 1:315 W LINCOLN RD
Practice Address - Street 2:SUITE B
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3850
Practice Address - Country:US
Practice Address - Phone:765-453-7692
Practice Address - Fax:765-453-7694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF INDIANA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty