Provider Demographics
NPI:1992858658
Name:PEDIATRIC DENTISTRY OF NORTHWEST INDIANA PC
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF NORTHWEST INDIANA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHECHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-462-8779
Mailing Address - Street 1:809 WALL ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2570
Mailing Address - Country:US
Mailing Address - Phone:219-462-8779
Mailing Address - Fax:219-531-2440
Practice Address - Street 1:809 WALL ST
Practice Address - Street 2:SUITE D
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2570
Practice Address - Country:US
Practice Address - Phone:219-462-8779
Practice Address - Fax:219-531-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100914OtherCHILDRENS SPECIAL HEALTH
IN755187OtherUNITED CONCORDIA