FORT WAYNE PEDIATRIC DENTISTRY LLC NPI 1689185886

NPI Information

FORT WAYNE PEDIATRIC DENTISTRY LLC is a pediatric dentistry dentist in Fort Wayne, IN. The provider is 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. FORT WAYNE PEDIATRIC DENTISTRY LLC NPI is 1689185886. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

10211 DUPONT CIRCLE DR W
FORT WAYNE, IN
ZIP 46825-622
Phone: (260) 490-5437

The provider's authorized official is Kevin Ludwig .
The authorized official title is Owner/pediatric Dentist and has the following contact phone number (219) 929-6739.

The CLIA number assigned to this NPI record is 15D1008013 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/16/2017 and was last updated on 10/16/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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