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Dr. Llyndall Rhett Fagg, DDSMSD
Pediatric Dentist in Michigan City, Indiana
NPI 1093715963

Llyndall Rhett Fagg is a Pediatric Dentist based in Michigan City, IN and is specialized in Pediatric Dentistry. Llyndall Rhett Fagg practices in Michigan City, IN and has the professional credentials of DDSMSD. The NPI Number for Llyndall Rhett Fagg is 1093715963 and holds a License No. 12007148A (Indiana).

The current practice location address for Llyndall Rhett Fagg is 211 Medical Plz, Michigan City, IN and can be reached out via phone at 219-879-4559 and via fax at 219-879-4559.

Location: 211 Medical Plz, Michigan City, IN, 46360-3364
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1093715963
Provider Name
Llyndall Rhett Fagg
Credential
DDSMSD
Provider Entity Type
Individual
Gender
Male
Address
211 Medical Plz, Michigan City, IN, 46360-3364
Phone Number
219-879-4559
Fax Number
219-879-4559
Provider Enumeration Date
07/21/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
200365570 05 IN
institution
Provider Business Practice Location Address Details
Address
211 Medical Plz
City
Michigan City
State
Indiana
Zip
46360-3364
Phone Number
219-879-4559
Fax Number
219-879-4559
person
Provider Business Mailing Address Details
Address
211 Medical Plz
City
Michigan City
State
Indiana
Zip
46360-3364
Phone Number
219-879-4559
Fax Number
219-879-4559
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
12007148A (Indiana)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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