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FORT WAYNE DENTAL GROUP LLC NPI 1922167188


NPI Information

NPI: 1922167188
Provider Name: FORT WAYNE DENTAL GROUP, LLC
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
7202 ENGLE RD
FORT WAYNE, IN
ZIP 46804
Phone: (260) 432-3459
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FORT WAYNE DENTAL GROUP, LLC is a general practice dentist in Fort Wayne, IN. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. FORT WAYNE DENTAL GROUP, LLC NPI is 1922167188. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

7202 ENGLE RD
FORT WAYNE, IN
ZIP 46804-222
Phone: (260) 432-3459
Fax: (260) 436-4757

The provider's authorized official is Brent E Mutton .
The authorized official title is Owner and has the following contact phone number (260) 432-3459.

The enumeration date for this NPI number is 12/6/2006 and was last updated on 8/22/2020.


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:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral Practice12008127INDIANAYes
21223G0001XDentistGeneral Practice12010298AINDIANAX
31223P0221XDentistPediatric Dentistry12009199INDIANAX

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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