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EON CLINICS INDIANA LLC

Dental Providers Dentist Periodontics

Provider NPI: 1538410451

Organization Information:
Organization Name:  EON CLINICS INDIANA LLC
Organization is not Subpart
Authorized Official:  RAJAN  SHARMA  PRESIDENT  219-924-5022

Practice Location:
10020 CALUMET AVE  MUNSTER, IN 46321-4055 US
Tel: 219-924-5022  Fax: --

Business Mailing Address:
10020 CALUMET AVE  MUNSTER, IN 46321-4055 US
Tel: 219-924-5022  Fax: --

NPI Information:
NPI: 1538410451
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N1223P0300XDental Providers
Dentist
Periodontics
IL021001569
N1223P0700XDental Providers
Dentist
IL021001569
Y1223S0112XDental Providers
Dentist
IL021001569

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 1223S0112X

Type:

Classification:



Definition:



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