| Radcliffe Family Dental, Llc | |
|
1901 Grant Street Gary IN 46404-2761 | |
| (219) 880-1430 | |
| Not Available |
| Full Name | Radcliffe Family Dental, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1901 Grant Street, Gary, Indiana |
| Authorized Official Name and Position | Trinoda Radcliffe (OWNER) |
| Authorized Official Contact | 2198801430 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Radcliffe Family Dental, Llc 1901 Grant Street Gary IN 46404-2761 Ph: (219) 880-1430 | Radcliffe Family Dental, Llc 1901 Grant Street Gary IN 46404-2761 Ph: (219) 880-1430 |
| NPI Number | 1023201175 |
|---|---|
| Provider Enumeration Date | 08/22/2007 |
| Last Update Date | 07/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023201175 | NPI | - | NPPES |
| 200860520 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 12010399A (Indiana) | Primary |
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