| Crossroads Pediatric Dentistry Pc | |
| 
					21781 Omega Ct Goshen IN 46528-7809  | |
| (574) 875-6531 | |
| (574) 875-8256 | 
| Full Name | Crossroads Pediatric Dentistry Pc | 
|---|---|
| Speciality | Clinic/center - Dental | 
| Location | 21781 Omega Ct, Goshen, Indiana | 
| Authorized Official Name and Position | Michael F Bigler (PRESIDENT) | 
| Authorized Official Contact | 5748756531 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Crossroads Pediatric Dentistry Pc 21781 Omega Ct Goshen IN 46528-7809 Ph: (574) 875-6531  | Crossroads Pediatric Dentistry Pc 21781 Omega Ct Goshen IN 46528-7809 Ph: (574) 875-6531  | 
| NPI Number | 1043319619 | 
|---|---|
| Provider Enumeration Date | 09/21/2006 | 
| Last Update Date | 02/07/2013 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1043319619 | NPI | - | NPPES | 
| 100065260 | Medicaid | IN | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 12007759 (Indiana) | Primary | 
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