Deardorff, Dale Dennis

Deardorff, Dale Dennis is an individual health care provider with primary practice located at 420 W 4Th St Suite 180, Mishawaka IN 46544-1948. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Deardorff, Dale Dennis can be contacted via phone (574) 247-3456.

Contact Information

Primary practice address
420 W 4Th St Suite 180 Mishawaka IN 46544-1948
Phone: (574) 247-3456
Fax: (574) 247-3455
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01025330 Indiana

Profile Details

NPI number 1043266653
LBN Legal business name Deardorff, Dale Dennis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 25th, 2006
Last updated Feb 23rd, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043266653 NPPES
Indiana MEDICAID 100220930A
Indiana Other 000000214800

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