Provider Demographics
NPI:1619072147
Name:GRANGER FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:GRANGER FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ANGLEMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-277-5406
Mailing Address - Street 1:12545 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9226
Mailing Address - Country:US
Mailing Address - Phone:574-277-5406
Mailing Address - Fax:574-277-5467
Practice Address - Street 1:12545 ADAMS RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9226
Practice Address - Country:US
Practice Address - Phone:574-277-5406
Practice Address - Fax:574-277-5467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009209B1223G0001X
IN12007958B1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty