| Shakamak Family Dentistry, Llc | |
|
206 S Meridian St Jasonville IN 47438-1520 | |
| (812) 665-2275 | |
| (812) 665-9374 |
| Full Name | Shakamak Family Dentistry, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 206 S Meridian St, Jasonville, Indiana |
| Authorized Official Name and Position | Steven W Kellett (OWNER) |
| Authorized Official Contact | 8126652275 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shakamak Family Dentistry, Llc 190 C St Nw Linton IN 47441-1328 Ph: (812) 847-8646 | Shakamak Family Dentistry, Llc 206 S Meridian St Jasonville IN 47438-1520 Ph: (812) 665-2275 |
| NPI Number | 1568992022 |
|---|---|
| Provider Enumeration Date | 06/18/2017 |
| Last Update Date | 06/18/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568992022 | NPI | - | NPPES |
| 201234800A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 12012106A (Indiana) | Primary |