| Pediatric Dentistry Inc | |
|
7750 West Jefferson Blvd Fort Wayne IN 46804-4136 | |
| (260) 459-0903 | |
| (260) 459-0673 |
| Full Name | Pediatric Dentistry Inc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 7750 West Jefferson Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Wayne Lee Dawes (PRESIDENT OWNER) |
| Authorized Official Contact | 2604590903 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentistry Inc 7750 West Jefferson Blvd Fort Wayne IN 46804-4136 Ph: (260) 459-0903 | Pediatric Dentistry Inc 7750 West Jefferson Blvd Fort Wayne IN 46804-4136 Ph: (260) 459-0903 |
| NPI Number | 1104859701 |
|---|---|
| Provider Enumeration Date | 07/08/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104859701 | NPI | - | NPPES |
| 104667 | Other | IN | IND DEPT OF HEALTH CHILDR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 54000382A (Indiana) | Primary |
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