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Pediatric Dentistry Inc
Pediatric Dentist in Fort Wayne, Indiana
NPI 1104859701

Pediatric Dentistry Inc is a Pediatric Dentist based in Fort Wayne, IN and is specialized in Pediatric Dentistry. Pediatric Dentistry Inc practices in Fort Wayne, IN. The NPI Number for Pediatric Dentistry Inc is 1104859701 and holds a License No. 54000382A (Indiana).

The current practice location address for Pediatric Dentistry Inc is 7750 West Jefferson Blvd, Fort Wayne, IN and can be reached out via phone at 260-459-0903 and via fax at 260-459-0673.

Location: 7750 West Jefferson Blvd, Fort Wayne, IN, 46804-4136
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1104859701
Provider Name
Pediatric Dentistry Inc
Credential
Provider Entity Type
Organization
Address
7750 West Jefferson Blvd, Fort Wayne, IN, 46804-4136
Phone Number
260-459-0903
Fax Number
260-459-0673
Provider Enumeration Date
07/08/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
104667 01 IN IND DEPT OF HEALTH CHILDR
institution
Provider Business Practice Location Address Details
Address
7750 West Jefferson Blvd
City
Fort Wayne
State
Indiana
Zip
46804-4136
Phone Number
260-459-0903
Fax Number
260-459-0673
person
Provider Business Mailing Address Details
Address
7750 West Jefferson Blvd
City
Fort Wayne
State
Indiana
Zip
46804-4136
Phone Number
260-459-0903
Fax Number
260-459-0673
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
54000382A (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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