Provider Demographics
NPI:1598963639
Name:PEDIATRIC DENTAL CARE, INC.
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KARR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-322-7610
Mailing Address - Street 1:1160 JOLIET ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-2096
Mailing Address - Country:US
Mailing Address - Phone:219-322-7610
Mailing Address - Fax:219-322-7611
Practice Address - Street 1:1160 JOLIET ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-2096
Practice Address - Country:US
Practice Address - Phone:219-322-7610
Practice Address - Fax:219-322-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010182A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty