| Koala Center For Sleep & Tmj Disorders - In3 | |
|
230 E Day Rd Ste 150 Mishawaka IN 46545-3463 | |
| (574) 800-5080 | |
| Not Available |
| Full Name | Koala Center For Sleep & Tmj Disorders - In3 |
|---|---|
| Speciality | Dentist |
| Location | 230 E Day Rd Ste 150, Mishawaka, Indiana |
| Authorized Official Name and Position | Rodney Willey (OWNER) |
| Authorized Official Contact | 3093030426 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Koala Center For Sleep & Tmj Disorders - In3 11825 State Route 40 Dunlap IL 61525-8842 Ph: () - | Koala Center For Sleep & Tmj Disorders - In3 230 E Day Rd Ste 150 Mishawaka IN 46545-3463 Ph: (574) 800-5080 |
| NPI Number | 1053936484 |
|---|---|
| Provider Enumeration Date | 06/11/2020 |
| Last Update Date | 09/10/2020 |
| Medicare PECOS PAC ID | 7911322649 |
|---|---|
| Medicare Enrollment ID | O20200729000372 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053936484 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
| Provider Name | Andrea R Beckford |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1043316557 PECOS PAC ID: 8921393265 Enrollment ID: I20200812001072 |
| Provider Name | Rodney Earl Willey |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1144409806 PECOS PAC ID: 4688746159 Enrollment ID: I20210519002968 |
| Provider Name | Heidi R Bell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821223488 PECOS PAC ID: 5294886750 Enrollment ID: I20211209002379 |
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