Provider Demographics
NPI:1962816777
Name:DENTAL ARTS GROUP, LLC
Entity Type:Organization
Organization Name:DENTAL ARTS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:UZELAC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-464-8532
Mailing Address - Street 1:850 MARSH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-6239
Mailing Address - Country:US
Mailing Address - Phone:219-464-8532
Mailing Address - Fax:219-548-8842
Practice Address - Street 1:850 MARSH ST
Practice Address - Street 2:SUITE A
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6239
Practice Address - Country:US
Practice Address - Phone:219-464-8532
Practice Address - Fax:219-548-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008155A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty