Provider Demographics
NPI:1932267515
Name:MICHIGAN CITY DENTAL, P.C.
Entity Type:Organization
Organization Name:MICHIGAN CITY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-874-7224
Mailing Address - Street 1:4212 E MICHIGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3131
Mailing Address - Country:US
Mailing Address - Phone:219-874-4449
Mailing Address - Fax:219-879-8153
Practice Address - Street 1:4212 E MICHIGAN BLVD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3131
Practice Address - Country:US
Practice Address - Phone:219-874-4449
Practice Address - Fax:219-879-8153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty