| Northwest Pediatric Dental Llc | |
|
8217 Wicker Ave St. John IN 46373 | |
| (219) 440-1710 | |
| Not Available |
| Full Name | Northwest Pediatric Dental Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 8217 Wicker Ave, St. John, Indiana |
| Authorized Official Name and Position | James R Mitsos (OWNER) |
| Authorized Official Contact | 2194401710 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Pediatric Dental Llc 8217 Wicker Ave St. John IN 46373 Ph: (219) 440-1710 | Northwest Pediatric Dental Llc 8217 Wicker Ave St. John IN 46373 Ph: (219) 440-1710 |
| NPI Number | 1982433819 |
|---|---|
| Provider Enumeration Date | 07/30/2024 |
| Last Update Date | 10/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982433819 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |