Provider Demographics
NPI:1831601566
Name:ARCH COMPLETE FAMILY DENTAL GROUP, INC.
Entity type:Organization
Organization Name:ARCH COMPLETE FAMILY DENTAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTYN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ARCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-310-8807
Mailing Address - Street 1:123 E 113TH AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9706
Mailing Address - Country:US
Mailing Address - Phone:219-310-8807
Mailing Address - Fax:219-779-9437
Practice Address - Street 1:123 E 113TH AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-9706
Practice Address - Country:US
Practice Address - Phone:219-310-8807
Practice Address - Fax:219-779-9437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental