Provider Demographics
NPI:1952462657
Name:FAMILY DENTAL CARE PC
Entity Type:Organization
Organization Name:FAMILY DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANBO
Authorized Official - Middle Name:
Authorized Official - Last Name:SIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-980-0319
Mailing Address - Street 1:6075 CLEVELAND CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-980-0319
Mailing Address - Fax:219-980-0379
Practice Address - Street 1:6075 CLEVELAND CIRCLE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-980-0319
Practice Address - Fax:219-980-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009372A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty