| Select Dental Associates Pc | |
|
1422 Lincoln Way E South Bend IN 46613-3250 | |
| (574) 232-8888 | |
| (574) 232-8929 |
| Full Name | Select Dental Associates Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1422 Lincoln Way E, South Bend, Indiana |
| Authorized Official Name and Position | Douglas J Kosek (OWNER) |
| Authorized Official Contact | 5743403423 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Select Dental Associates Pc 1422 Lincoln Way E South Bend IN 46613-3250 Ph: (574) 232-8888 | Select Dental Associates Pc 1422 Lincoln Way E South Bend IN 46613-3250 Ph: (574) 232-8888 |
| NPI Number | 1457850687 |
|---|---|
| Provider Enumeration Date | 02/02/2018 |
| Last Update Date | 02/02/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457850687 | NPI | - | NPPES |
| 12010354A | Other | IN | STATE LICENSE |
| 12012866A | Other | IN | STATE LICENSE |
| 200214390 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 12009873 (Indiana) | Primary |
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