NPI 1093122418

Miracle Lane Family Dentistry P.C.

Organisation Dental Clinic/Center Mishawaka, IN

Practice location

Address: 2332 Miracle Ln, Mishawaka, IN 46545-3012
Phone: (574) 259-5437
Fax: (574) 259-5438

Authorised official

Name: Bridget Lynn Merritt-Brooks
Title: Dentist/Owner
Phone: (313) 610-4688

Registered specialties

Dental Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261QD0000X Licence 54001789A (IN)

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Registry record

NPI: 1093122418
Entity type: Organization
NPI issued: 17 Jul 2014
Record last updated: 17 Jul 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.