Provider Demographics
NPI:1518220946
Name:TRANSITIONS DENTAL COMPANY
Entity Type:Organization
Organization Name:TRANSITIONS DENTAL COMPANY
Other - Org Name:UNIVERSITY MEADOWS FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARRI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-807-0580
Mailing Address - Street 1:6502 GRAPE RD
Mailing Address - Street 2:SUITE 882
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1102
Mailing Address - Country:US
Mailing Address - Phone:574-698-3719
Mailing Address - Fax:574-968-8140
Practice Address - Street 1:6502 GRAPE RD
Practice Address - Street 2:SUITE 882
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1102
Practice Address - Country:US
Practice Address - Phone:574-698-3719
Practice Address - Fax:574-968-8140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANSITIONS DENTAL COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010165122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty