| Organization Name: | CROSSROADS PEDIATRIC DENTISTRY PC |
| NPI Number: | 1043319619 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL F BIGLER (PRESIDENT) |
| Mailing Address: | 21781 Omega Ct Goshen |
| State: | IN US |
| Postal Code: | 465287809 |
| Phone Number: | 5748756531 |
| Fax Number: | 5748758256 |
| NPI Enumeration Date: | 09/21/2006 |
| NPI Last Update Date: | 02/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 12007759 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |